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SENT <br /> United States Department of the Interior G <br /> FISH AND WILDLIFE SERVICE <br /> . <br /> if <br /> 'A 1875 Century Boulevard <br /> Atlanta, Georgia 30345 <br /> In Reply Refer to : <br /> FWS/R4/CRF/RF July 2004 <br /> FY 2003 <br /> REFUGE REVENUE SHARING PAYMENT FORM <br /> (October 1, 2002 - September 30, 2003) <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 COUNTY/PARISH 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 (78 <br /> Stat. 252 ; 42 U . S . C . 2000d) and in compliance with the regulations issued pursuant thereto, which are contained in 43 CFR <br /> Part 17 (forfurther information, search the Internet for Code of Federal Regulations 43 CFR Part 17 Nondiscrimination in <br /> Federally Assisted Programs of the Department of the Interior). <br /> COUNTY/PARISH REPRESENTATIVE TITLE DATE <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 95-469) <br /> COUNTY/PARISH of Indian River County STATE of FI ori d ;; <br /> The check represents the GREATER of: three-fourths of 1 percent (0 .75 percent) of the fair market (appraised) value of fee <br /> land acquired, or 25 percent of net receipts, or 75 cents per acre for fee lands located within the National Wildlife Refuge <br /> System in the same County/Parish. <br /> RECEIVED BY : <br /> r r <br /> : �Zc , tom✓ ' i1c ,.(� Chairman <br /> COUNTY/PARISH REPRIESENTATIVE TITLE DA �E <br /> 3151 52478493 $ 77 , s34 on <br /> CHECK NO. CHECK AMOUNT <br /> (Please return this signed form to Charlotte Underwood (404/679- 7216) in the self-addressed envelope attached. ) <br />