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Cont'd from pg 2. �X ff i X317— Application TApplication Evaluation Review Sheet Applicant Name: Appl. #12: Address: P.O. Box 998, Vero Beach, FI. 32961 Tract Number(s): Colby, Begley, Nason, Banyan, Banyan 2, Ausby, Sunchief, Sunchief 10, Warren, McAnney, Greene, Eubanks, K& G, Buck, , Fromang, Holland. Date: Nov. 16, 2002 Vl.'lteview s5tllmmig Land Use/Field: Acres: Micro-Irrigated Citrus Grove 463 Best Management Practices Applied For: 3. Precision Application Equipment Total BMP Costs: 60%Cost Share: Div by Total Eval Points: Div by Acres,times 100 =Applicant Score Applicant Cost: $14,32, $8,597 20 92.83 Ull. tetnarks VIII. designated-Conservationist: (Signature) Dat4. (Checked By) Date: IRSWCD Board Approval Date � V, 6 -rv:7 �';z/ - (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 fumished 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. Page 3 IRSWCD (10-26-01)