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SPECIAL MAGISTRATE APPLICATION <br /> z,,,y,�.:;...), <br /> )•)) <br /> INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD • <br /> i (APPLICANTS MUST MEET QUALIFICATIONS OUTLINED IN FLA.STAT.§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? [j No 0 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 /> • <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 cdnflict 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 /> . <br /> CERTIFICATION <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 tax year that he/she services the Board as a special magistrate,represents a'party before the Board in . <br /> ii any administrative review of property taxes. . • • <br /> i <br /> Are you an elected'or appointed official or employee of a county,a taxing jurisdiction,or the state?0 Yes 10 No <br /> • <br /> If yes,please provide details: - <br /> The undersigned certifies, under penalty of disqualification from consideration, that each item contained in this <br /> application,'o any , r:document furnished by or on behalf of the applicant is true and complete as of the date it ' <br /> .' bears. The un •rsigned harizes the Value Adjustment Board to obtain information from other sources to verify <br /> each item contai •d herein. e undersigned acknowledges that, if selected,he/she will follow all requirements and <br /> mandates of law in 1 filling the,uties of special magistrate. . • <br /> t I • <br /> ,,V • .a . • 4/18 . • . <br /> Signatu ; of •p . • <br /> • <br /> Karen Wonsetler • <br /> Printed Name of Applicant ' <br /> . v <br /> • <br /> • <br /> • <br /> • <br /> • <br /> Page 3 <br /> • • v01/13/2015 <br /> • <br /> • - 13 - • <br />