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Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : W. C . Graves III Address : P . O . Box 998 , Vero Beach , FI . 32961 Tract Number(s) : Sunchief 10 Field Number(s) . Date . January 14 , 2003 V1. Review Summary: Land Use/Field : Acres : Micro-Irrigated Citrus Grove 10 Best Management Practices Applied For: 2. Install 1 FBR H2o Control Structure. Total BMP Costs: 6% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: $ 11 , 597 $8 , 698 25 347 . 91 $2 , 899 . VII . Remarks : 61 V1114 Designated Conse tionist: o i � 3 Q3 (Signature) Dat94 (Checked By) Date: IRSWCD Board Approval Date _ (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 )