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12/6/2012 <br />INDIAN RIVER COUNTY <br />SOLID WASTE DISPOSAL DISTRICT <br />1801 27T11 STREET, VERO BEACH, FLORIDA 3296(1-3365 <br />VACANCY CREDIT <br />VERIFICATION CHECKLIST <br />Please submit the following information along with your signed and notarized request for <br />Vacancy Credit: <br />1. Rent Roll <br />a. unit leased to tenant <br />b. square footage of unit leased to tenant <br />c. name of tenant <br />d. lease Agreement <br />i. Start date and expiration date of lease. <br />ii. Amount of rent paid by tenant for unit. <br />in. Pass through amount paid by tenant for common area <br />2. Start Date Utilities (for each tenant) <br />a. electric. <br />b. water <br />c. telephone <br />End Date Utilities (for each tenant) <br />a electric <br />b. water <br />c. telephone <br />Vacancy Credit may be applied to commercial properties based upon the vacancy status of <br />the property for a period of one year January 1 - December 31 prior to the tax year the <br />annual assessment becomes due. Vacancy Credit may not be applied to prior year <br />assessments. Credit will be applied only upon the property owner p► aviding substantial <br />verification that moi c than 59b/0 of the property was vac int for a period greater than 180 <br />consecutive taus within the period for which credit is allowed. <br />WARNING THE MAKING OF A FALSE STATEMENT UNDER OATH MAY <br />CONSTITUTE PERJURY, PUNISHABLE IN ACCORDANCE WITH CHAPTER 837, <br />FLORIDA STATUTES ALSO, THE MAICING OF A FALSE STATEMENT WITH THE <br />INTENT TO MISLEAD A PUBLIC SERVANT IN THE PERFORMANCE OF HIS OR <br />HER OFFICIAL DUTY MAY BE PUNISHABLE IN ACCORDANCE WITH SECTION <br />837.06, FLORIDA STATUTES. <br />3 of 3 <br />F:\SWDD\VACANCY CREDIT12013 VACANCY CREDIT REQUEST FORM dnR #6 of 6.doc <br />