Laserfiche WebLink
SPECIAL ASSESSMENT AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) ss. <br /> COUNTY OF INDIAN RIVER ) <br /> BEFORE ME, the undersigned authority, duly authorized in the State and County aforesaid to <br /> take acknowledgments, personally appeared Kenneth Watson, as President of Bent Pine Golf Club, <br /> Inc., a Florida not-for-profit corporation, who after being duly sworn deposes and says the <br /> undersigned is the Owner of the following described property, to-wit: <br /> See EXHIBIT "A" attached hereto and incorporated herein by reference. <br /> PLEASE CHECK 1 OR 2 <br /> 1. I HAVE received Notice of Utility, Paving, Water, Special, Impact, <br /> Development, Waste and/or Sewer Assessment(s). <br /> Please explain: <br /> 2. I HAVE NOT received Notice of Utility, Paving, Water, Special, Impact, <br /> Development, Waste and/or Sewer Assessment(s). <br /> Signed, sealed, and delivered in OWNER: <br /> the presence of: <br /> Bent Pine Golf Club, Inc., <br /> a Florida not-for-profit corporation <br /> _4LIi � <br /> (Name: M 2 <br /> c?F41- <br /> By. <br /> ` — <br /> (Name: Shercri SWamSo!j ) Kenneth Watson, President <br /> SWORN TO AND SUBSCRIBED before me by Kenneth Watson, as President of Bent Pine <br /> Golf Club, Inc., a Florida not-for-profit corporation, this 16th day of May, 2016, who did <br /> acknowledge and swear before me that said person executed the foregoing instrument for the uses and <br /> purposes therein set forth on behalf of said corporation. I further state that (check one) e I have <br /> examined the current driver's license of the aforesaid person, or I am familiar with the identity of <br /> the aforesaid person and have confirmed said person's identi <br /> (My commission expires) -d-A-I'l NOTARY PUBLIC, State of Florida <br /> (Name: c5 k e rt I' S of am S oYL ) <br /> .6.77;."' SHERRI SWANSON <br /> =4 = MY COMMISSION 4 FF 042814 <br /> p•. EXPIRES:September 22,2017 <br /> �•;e••••'�'' <br /> Bonded Thru NOWY ubr.Undervrrders <br />