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Cont'd from pg 2 . _ E >( Vi I Application Evaluation Review Sheet Applicant Name : App # 328 : Michael Monroe Address : 7387 61st Street , Vero Beach , FL 32967 Tract Number(s) : Field Number(s) : Home Grove Date : Nov . 6 , 2003 VI. Review Summary: Land Use/Field : Acres . Micro-Irrigated Citrus Grove 10 Best Management Practices Applied For: 2. Install 1 FBR H2o Control Structure. Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: $3 , 712 . 00 $2 , 784 25 111 . 36 $928 . 00 Vil. Remarks VIII. Designated Conse ionist: (Signature) Date: (Checked By) Date: ' Ir � l! - iv -dam IRSWCD oard Approval Date _ 1TJD3 (Applicant Signature) Date Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U .S .C . 522a) . The authorities for requesting the information to be applied on this form are: 16 U .S .C . 590a-f (Soil and Water Conversation) ; 16U .S .C . 3801 et seq . (Food Security Acto of 1985, as ammended) , and the regulation promulgated theruder. The information requested is necessary for the evaluation of an application , development and implementation of a conservation plan as the basis for satisfying program eligibility and compliance requirements, and for providing technical education, or financial assist- ance under the previously mentioned authorities. Furnishing this information is voluntary; however, failure to fumish correct, complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. This information may be fumished to other USDA agencies , the Internal Revenue Service, the Department of Justice, or the other State or Federal law enforcement agencies, or in response to orders of a court, magistrate, or administrative tribunal . IRSWCD Page 3 ( 10-26-01 )