Laserfiche WebLink
Section III <br />Real Property <br />Complete this section only if purpose number 1 <br />Property described in Section I is used as follows: <br />Residential • Apartment Building <br />Shopping Center • Agncultural <br />■ <br />■ <br />■ <br />■ <br />Duplex <br />Industrial <br />■ <br />■ <br />or 3 in Section I is checked. <br />Hotel <br />Motel <br />■ <br />■ <br />Store <br />Other <br />Petition No. <br />Office <br />Vacant <br />DR -486 <br />R. 12/96 <br />Page 2 <br />D id you purchase land and building? Total price $ <br />D ate purchased Total cost of building $ <br />Cost'of land $ Cost of improvements after purchase $ <br />D ate Built Mortgage (if any) in amount of $ <br />D ate of Mortgage Balance Due $ <br />Amount of Insurance $ Age of Building <br />Is property rented or leased? ■ Yes • No If yes. Net Income $ Gross Income $ <br />Is property agricultural? ■ Yes • No If yes. Type of agricultural use <br />Total acreage <br />Acreage under agricultural use <br />Professional appraiser's report of value (if available) $ <br />Section IV <br />I am willing to submit any additional information pertinent to this petition. • Yes <br />D ave you discussed this assessment with the property appraiser prior to filing this petition'? Yes • No <br />If "No", was a conference requested9 ■ Yes ■ No <br />■ <br />No <br />State of Florida <br />County of --Lir\ m• L—. \\ <br />Before me, the undersigned authority, personally appeared J — � ��` ^ • ✓`•4P_. Z, <br />who in my presence subscribed the foregoing petition and who after having been duly sworn deposed and said that he or she is the <br />owner of the property described in Section I of the foregoing petition, that the above and foregoing statements of matters, facts, values <br />and any exhibits attached are true and correct. <br />■ <br />• <br />Sworn to (or affirmed) and subscribed before me this <br />by 3Lart &am►tf}Z <br />[Name of Petitioner] <br />NOTARY PUBUC SLUT OF FLORIDA <br />Athena M, Adams <br />Commission * DD396207 <br />Expires: FEB, 14, 2009 <br />son •ed Thru Atlantic Bonding Co,, Inc, <br />Print, Type or Stamp Commissioned Name of Notary <br />day of <br />Receipt <br />TU ckSn_MiLe..2.•. <br />[Signature of Petitioner] <br />Personally Known <br />OR Produced Identif tion /2-4 <br />1 <br />Type of Identification Produced 1L- bl., I r- `S 2 <br />Signature of Notary <br />I hereby certify that the foregoing petj ion to the Value Adjustment Board was filed with the undersigned as the clerk of the governing <br />body of this county on the Re day of U/catA.GL.— pAc (a.m., p.m.) and the signing and <br />delivery of a copy by me to the petitioner constitutes a receipt of the samn., I further certifty hat a copy of the foregoing petition was <br />furnished by me to the property appraiser of this county on the 2�—r - day of LIJ� a-4. C L._ '-lee C. <br />White - clerk's copy <br />County Clerk <br />Yellow - appraiser copy <br />Smeadsort Reprint Date: Wednesday, October 20, 2010 - 14:26:44 - OKcialDocuments:1451, Attachment Id 1, Page 22 <br />Pink petitioner copy <br />