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1 <br /> Cont'd from pg 2 . <br /> Applicabc"i-EvaluafiGm Review-Shee <br /> Applicant Name : Applicant #411 ; Ray 9 Smith High Brix, Inc. <br /> Address : 14776 Old Dixie Highway , Vero Beach , FL 32961 <br /> Tract Number(s) . <br /> Field Number(s): 1 <br /> Date : July 9 , 2004 <br /> P 6 nm--« =777 <br /> ^faam' . -xt rn <br /> Y 77717 <br /> Land Use/Field . Acres : <br /> Micro-Irrigated Citrus Grove 127 <br /> Best Management Practices Applied For: <br /> Install 1 FBR H2o Control Structure. <br /> Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: <br /> $ 11 , 3651 $8, 524 1 25 340 . 95 $2 , 841 <br /> � yg,,ry el\1Qi71t F y A .r, <br /> #Ir411Ir lIISLY ir <br /> 1 1 , <br /> '0000 <br /> et <br /> - <br /> (Signatu�re)� D - (Checked By) Date: <br /> 2�rt�:,e L(/ t <br /> IRSWCD Board App pie <br /> . el <br /> (Applicant Signature) Date <br /> Privacy Act Staternent: The following statements are made in accordance with the Privacy Act of 1974 (SU .S.C . 522x). <br /> The authorities for requesting the information to be applied on this form are: 16 U .S .C. 590a-f (Soil and Water Conversation); <br /> 16U . S.C. 3801 et seq. (Food Security Acto of 1985, as ammended) , and the regulation promulgated theruder. The information <br /> requested is necessary for the evaluation of an application, development and implementation of a conservation plan as the <br /> basis for satisfying program eligibility and compliance requirements, and for providing technical education, or financial assist- <br /> ance under the previously mentioned authorities. furnishing this information is voluntary; however, failure to fumish correct, <br /> complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. This <br /> information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or the other <br /> State or federal law enforcement agencies, or in response to orders of a court, m istrate, or administrative tribunal. <br /> IRSWCD <br /> Page 3 (10-26-01 ) <br />