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7 � Application For Revenue Sharing 2004-2005 State Fiscal Year DR-700218 R . 04/04 (Chapter 218 , Part II Florida Statutes) a L, / 7 DEPARTMENT OF REVENUE Application must be received by the Department of Revenue prior to June 30, 2004 Please TYPE or PRINT all entries except those requiring a signature . Part One Name of County Indian River OR Name of Municipality County Telephone Number ( 772 ) 567 - 8000 Fax Telephone Number ( 772 ) 770 - 5331 Mayor or Chairman of Governing Body Caroline D . Ginn Chief Fiscal Officer Jeffrey K . Barton Official Mailing Address 1840 25th Street Vero Beach , FL 32960 - 3365 F Check here if the address represents a change from the previous application . Federal Employer I . D . Number ( required for new participants only) . Part Two To be eligible to participate in Revenue Sharing beyond the minimum entitlement as defined in s . 218 . 21 (7 ) , F. S . , for any fiscal year, a unit of local government is required to have fulfilled certain requirements set forth in s . 218 . 23 , F. S . , including certification requirements . Signatures by the appropriate official in the signature blocks , where applicable , shall constitute fulfillment of the certification requirements set forth in s . 218 .23 , F. S . Consistent with the requirements of s . 218 . 23 , F. S . , has the applicant: Note: Question 1 and 2 pertain to financial audit requirements . If a financial audit was required, report on the most recently completed audit period . Fiscal year ending 09/30/02 will be sufficient for this purpose . 1 . Reported its finances for its most recently completed fiscal year to the Department of Banking and Finance , pursuant to s . 218 . 32 , F. S . ? Yes No 2 . Made provisions for annual postaudits of its financial accounts in accordance with s . 11 .45 , F. S . ? Yes No January 30 , 2004 Date of Audit Report