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FUND <br />icy D <br />DATC--- <br />TL <br />OR - 462 <br />Revised 12!78 / <br />(Sec. 195.106, F.S.) <br />DEPARTfa E <br />REQUISITION FOR REFUND OF AD/t A1.ORF:e1 ,mv:S <br />STATE OF F LORMA <br />COUNTY OF <br />INDIAN RIVER <br />Ptirsuant to Section 195.106, Florida Statutes, <br />O'Haire, Peterkin & Moran <br />(Pacee) <br />of 2145 15th Ave., Vero Beach, F1'.. <br />(Residence) <br />flerebv makes application to the Uepartinent of Revenue for refund of• S 403.11 <br />(Aillotuit) <br />of moneN-s paid to the Comity. Tax Collector and as grounds therefor sets uli the folloHi i., fact.:: <br />(Slate reason for Refund) <br />County Property Appraiser has issued a Certificate of Correction No. 5-35947' <br />to reduce the assessed value on building which reduces the Just and Taxable <br />value to $64,470, thus reducing the gross 1977 tax to $1,322.29. With the <br />allowance of 4% discount there is a refund due of $403.11. There are attached <br />copies showing a refund was approved in June 1979 and this is the second <br />reduction in value and. request for refund. <br />Allached hereto is additional proof to establish such claiiu, :is fomms: <br />Copy of Certificate of Correction No. 5-35947 <br />Copy of Certificate of Correction No. 5-35868 (formerly approved) <br />Copy of 1977 Tax Receipt <br />Copy of DR Form 462 approving the first request for refund <br />Sworn and subscrilwd to <br />Ix -fore nie this 22 day <br />of January_, 19 80 <br />Notary Public <br />Rotary Pubtu, State cf Florida at 1uq4 <br />Nsy Coriimission Expires Oct. 6. 1730 <br />{DnN'j H A..ot.0o. h.* • 4..60, coo.W/ <br />O'Haire, Peterkin & Moran <br />MAR 51900tOOK <br />