Okaloosa County BOCC — November 3, 2015 — OCSO LETF Application page 3 of 3 pages

- Upon completing this application in its entirety, please read the following statement and affix your | signature accordingly. I have read, fully understand and agree to be bound by Okaloosa County’s Operating Procedures for Law Enforcement Trust Fund and applicable state statutes. | have completed this application fully and accurately and have not misrepresented any information contained herein. I certify that the requested funds will be used for the purposes set forth in this application and in conformity with Florida law. 1 agree to submit proper supporting documentation within ninety (90) days of expending the LETF proceeds, which establishes that such proceeds were expended for the purposes they were approved and in conformity with Florida law. I further agree that should I fail to provide such documentation within the specified time period, I will be responsible for reimbursing Okaloosa County for the amounts received, ool _f JubS October 6, 2015. Signature of Applicant Date of Application Charles E. Schuster Print Name of Applicant OFFICIAL USE ONLY i I, Larry R. Ashley, do hereby certify that the aforementioned request for LETF proceeds is in compliance with Section 932.7055, Florida Statutes, Sheriff Larry R. Ashley Board of County Commissioners: Approved/Disapproved Date: Amount approved: $