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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) : Warren Field Number(s) : Date , January 14 , 2003 VI. Review Summary: Land Use/Field : Acres : Micro-Irrigated Citrus Grove 40 Best Management Practices Applied For: 2. Install 2 FBR H2o Control Structures. Total BMP Costs : 75% Cost Share. Div By Total Eval Points : = Applicant's Score: Applicant Cost, $ 11 , 662 . $ 87747 50 174 . 93 $2 , 915 .. VII. Remarks : Vlll . Designated Conse ationist: All 03 j3 p3 (Signature) I N4- F (Checked By) Dae: IRSWCD Board Approval Date �` i iZ � 6) (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 )