Laserfiche WebLink
INDIAN RIVER COUNTY <br />SOLID WASTE DISPOSAL DISTRICT <br />1801 2710 STREET, VERO BEACH, FLORIDA 32960-3365 <br />12/6/2012 <br />2013 VACANCY CREDIT REQUEST <br />vacancy: more than 180 consecutive days between January 1, 2012 - December 31, 2012 <br />Vacancy Credit Request filing deadline is April 15, 2013 <br />Please attach Vacancy Credit verification to this request. <br />Type or print all information clearly <br />DATE <br />PARCEL IDENTIFICATION NUMBER: <br />IMP <br />PARCEL OWNER NAME <br />MAILING ADDRESS <br />TELEPHONE NUMBER <br />E-MAIL ADDRESS <br />FAX NUMBER <br />AGENT NAME <br />MAILING ADDRESS <br />TELEPHONE NUMBER <br />E-MAIL ADDRESS <br />FAX NUMBER <br />B USINESS NAME <br />B USINESS ADDRESS <br />SP <br />• <br />PARCEL OWNER (or Agent) SIGNATURE <br />STATE OF <br />COUNTY OF . The foregoing instrument was acknowledged before me this day of <br />, before me, by <br />(month) (year) (parcel owner) <br />Peisonally Known :. or Produced Identification ._. <br />Type of Identification Produced: <br />(Notary signature) <br />(Print Name of Notary) <br />NOTARY PUBLIC, State of <br />My Commtsston expires: <br />1 of <br />F.\SWVDDIVACANCY CREDIT12013 VACANCY CREDIT REQUEST FORM draft #6 of 6.doc <br />(scat) <br />