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Cont'd from pg 2 . Fxh ( b IT 'B Application Evaluation Review Sheet Applicant Name : App . # 330 , Hammond Groves Address : P . O . Box 3278 Vero Beach , FI 32964 Tract Number(s ) : Field Number(s) : Heritage , Bates Date : Nov . 6 , 2003 VI . Review Summary: Land Use/Field : Acres : Micro-Irrigated Citrus Grove 55 Best Management Practices Applied For: 2. Install 4 FBR H2o Control Structure, Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: $32 , 361 . 001 $24 , 271 100 242 . 71 $87090 VII. Remarks : VlIk Designated servationist: (Signature) I Dat4: I (Checked By) ate: fan al ",< a e, l /C) �C5 IRSW D Board Appro Date - t-e) (Applicant Signature) 7 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 furnish correct, complete information will result in the withholding or withdrawal of such technical , educational, or financial assistance. This information may be furnished 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 )