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SPECIAL MAGISTRATE APPLICATION <br />` INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD <br />(APPLICANTS MUST MEET QUALIFICATIONS OUTLINED IN FLA. STAT. S 194.035) <br />3. Have you ever been disbarred, suspended or received any other disciplinary action. from any organized <br />association, or from the State of Florida? M No ❑ Yes (please explain) <br />4. List any personal or business relationship you have ever had with any officer or employee of the office of the <br />property appraiser, office of the clerk of the circuit court, office of the county attorney or the value adjustment <br />board of any of the counties to which you are applying: <br />None. <br />5. List any clubs, organizations, associations, or other entities to which you belong or participate in and in which a <br />possible conflict of interest could occur or the appearance of a conflict of interest might arise that would prevent <br />you from fairly conducting the hearing between the property appraiser and the property owner and taxpayer. <br />None. <br />I <br />Pursuant to Fla. Stat. § 194.035, a person cannot serve as a special magistrate if he/she is an elected or appointed <br />official of a county, a taxing jurisdiction, or the state; is an employee of a county, a taxing jurisdiction, or the state; <br />or in the same fax year that he/she services the Board as a special magistrate, represents a'party before the Board in <br />any adminisfrative review of property taxes. <br />Are you an elected• or appointed official or employee of a county, a taxing jurisdiction, or the state? Yes No <br />If yes, please provide details: <br />The undersigned certifies, under penalty of disqualfcation from consideration, that each item contained in this <br />application, •o any j :document furnished by or on behalf of the applicant is true and complete as of the date it <br />bears. The un rsigned horizes the Valua Adjustment Board to obtain information from other sources to verb <br />each item contai d harem. Yke undersigned acknowledges that, if selected, he/she will follow all requirements and <br />mandates of law in l filling the uties of special magistrate. . <br />Signatut of AppHearttl <br />Karen Wonsetler <br />Printed Name of Applicant <br />u <br />Page 3 <br />v01/1312015 <br />-13- <br />