2024-144 - Laserfiche WebLink

Home Browse Search

APPLICANT SIGNATURE A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L. BUTLER, CLERK Application is hereby made for the activities described herein. I certify that I am familiar with the information contained in the application, and to the best of my knowledge and belief, this information is true, complete, and accurate. I further certify that I possess the authority (see grant guidelines Section IV, 4.4) to sign on behalf of the Applicant and that the Applicant has the ability to undertake the proposed activities in compliance with the FWC Derelict Vessel Removal Grant Program Guidelines. I also certify that the applicant's governing body is aware of and has authorized the project manager as the official representative of the applicant to act in connection with this application and subsequent project, as well as to provide additional information as may be required. By my signature below, the applicant agrees to comply with all applicable federal, state, and local laws in conjunction with this proposal and the resulting project if approved. Print/Type Name. Signature: Susan Ada STATE OF FLORIDA, COUNTY OF SELECT ONE INDIAN RIVER Title: Chairman Date: Jul Susan Adams personally, appeared before me this 2nd 2024 who subscribed and swore to the above instrument in my presence. 2, 2024 day of Jul Notary Public Name: Kimberly K. Moirano V"*^ )ely644"'�+d My commission expires: April 2027 NOTE: Instruction and further information regarding this application and the FWC Derelict Vessel Removal Grant Program can be found in the Program's Guidelines document or by contactin a Fish and Wildlife Conservation Commission, Boating and Waterways Section, ,esseI b9kW th Meridian Street, Tallahassee, FL 32399-1600 or call (850) 488-5600 +� :�`_. MYCOMMIS"#HH3N1l2S EXPIRES: Apel 9, 2027 APPROVED AS TO FORM AND A U ICI Y BY , WILLIAM K. 15EEIRAAL COUNTY ATTORNEY Attest: Ryan L. Butter, Clerk of Circuit Court and Comptroller FWC/DV-APP (Feb 2020) 5 Rule 68-1.003