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VENT of rhE. �7 <br /> United States Department of the Interior _ <br /> _ FISH AND WILDLIFE SERVICE <br /> H s 1875 Century Boulevard <br /> Atlanta, Georgia 30345 <br /> In Reply Refer to: July 2003 <br /> FWS/R4/ARW/U <br /> FY 2002 <br /> REFUGE REVENUE SHARING PAYMENT FORM <br /> (October 1 , 2001 - September 30, 2002) <br /> (PART 1 ) : <br /> COUNTY COMPLIANCE CERTIFICATION <br /> (With Section VI of the Civil Rights Act of 1964 <br /> Pertaining to Refuge Revenue Sharing Payments) <br /> The undersigned assures that T N n T n N u T vER COUNTY/f ARM will administer payments <br /> under the Refuge Revenue Sharing Act ( 16 U.S.C . 715s) in accordance with Section VI of the Civil Rights Act of 1964 <br /> (78 Stat. 252% 42 U. S.C . 2000d) and in compliance with the regulations issued pursuant thereto, which are contained in <br /> rFar, 17 (se ; or search Internet for Code of Federal Regulations 43 CFR Part 17 revised 101112002). <br /> � Chairman AlgtiGt• 12 , � n03 <br /> CO NTY/PpW RIEPRESENTATIVE TITLE DATE <br /> Kenneth R . Macht <br /> (PART 2) : <br /> RECEIPT FOR CHECK <br /> This annual payment is made in accordance with the Refuge Revenue Sharing Act <br /> (amended in 1978 by Public Law 95469) <br /> COUNTY/PABd&i Of INDIAN R VER _STATE Of FLORIDA <br /> The check represents the GREATER of: three-fourths of 1 percent (0. 75 percent) of the fair market (appraised) value <br /> of fee land acquired, or 25 percent of net receipts, or 75 cents per acre for fee lands located within the National Wildlife <br /> Refuge System in the same County/Parish. <br /> REC D BY ** <br /> Chairman August 12 , <br /> 2003 <br /> COUNTY/PI REPRESENTATIVE TITLE DATE <br /> Kenneth R . Macht 3151 52049000 $ 80 , 982 . 00 <br /> CHECK NO. CHECK AMOUNT <br /> (Please return this signed form to Charlotte Underwood (404/679- 7216) in the self-addressed envelope attached) <br />