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1 , 4 e tO Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : Appl . #334 : Thomas Hammond , Hammond Groves Address : 13885 41 St. Vero Beach , FL32964 Tract Number(s) . Field Number(s) : JAH in Indian River County Date : INov . 7 , 2003 VL Review Summary: Land Use/Field . Acres : Citrus Groves 17150 Best Management Practices Applied For. 3. Precision Application Equipment ( 1 piece of equipment). Total BMP Costs: 60% Cost Share: Div by Total Eval Points: Div by Acres, times 100 = Applicant Score LL Applicant Cost: $ 12 , 000. 00 $ 7, 200 20 31 . 30 $4 , 800 . 00 VII. Remarks . h , VY). Designated Con ationist: 7 d Al . x . 0 3 (signature) ate: (Chec By) Date: R Q IRSWCD Board Approval Date a - -7 --v (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 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 )