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e DR-700216 R . 05/03 Page 2 3 . Levied , as shown on its most recent financial report, pursuant to s . 218 . 32 , F. S . , ad valorem taxes , exclusive of taxes levied for debt service or other special millages authorized by the voters , to produce the revenue equivalent to a millage rate of three ( 3 ) mills on the dollar based on the 1973 taxable values as certified by the property appraiser, pursuant to s . 193 . 122 (2) , F. S . , ® Yes 0 No OR In order to produce revenue equivalent to that which would otherwise be produced by such a three (3 ) mill ad valorem tax : (A ) to have received a remittance from the county pursuant to s . 125 . 01 (6 ) ( a) , FS . ; ( B ) collected an occupational license tax; (C ) collected a utility tax; ( D ) levied an ad valorem tax; ( E ) received revenue from any combination of these four sources ? Yes No 4. Certified that: (A) Law enforcement officers , as defined in s . 943 , 1 0 ( l ) , F. S . , employed by this Unit meet the qualifications for employment as established by the Criminal Justice Standards and Training Commission ? X Yes E::] No ( B) The salary structure and salary plans for law enforcement officers meet the provisions of Chapter 943 , F.S . ? Yes No ( C ) All law enforcement officers , as defined in s . 943 . 1 0 ( 1 ) , F. S . , are compensated at an annual salary rate of six thousand dollars ($6 , 000) or more ? Yes No [ If the answer to (C) above is ( NO) , please state in an addendum to this application any reason you may have for waiver of such requirement ( one of which must be that you are levying ten ( 10 ) mills of ad valorem taxes) . ] Signed : Date : _ 5? / AppropGatte Law Enf rcement Officer F'] [If you have no police department , etc . , please check the block to the left side .]