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:a .l SPECIAL MAGISTRATE APPLICATION <br />INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD <br />(APPLICANTS MUST141EET 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? © 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 />Business relationships through the VAB process. <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 />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, pr the state; <br />or in the same tax year that he/she services the Board as a special magistrate, represents a patty before the Board in <br />any administrative review of property taxes. <br />Are you an elected or appointed official or employee of a county, A taxing jurisdiction, or the state? ❑ Yes R1 No <br />If yes, please provide details: <br />The :mdersigned certifies, tinder penalty of disqualifrcatim fr-om consideration, (hat each item contained 'in this <br />application, or arab) other docinnent fr►rnished by or on behalf of the applicant is true and complete as of the clale it <br />bears. The unclersigned authorizes the Malue Adjustment Board to obtain infoPmdiion fr•orn olher sources to verb <br />each item contained her ' t. The nmdeisigned acknowledges that, if selected, he/she willfollow all requirements and <br />mandatesof lmu' in f- rt ing the duties of special magistrate. <br />Date: 6/1/18 <br />of A <br />i G. <br />Printed Name of Applicant <br />Page 3 <br />v01/13/2015 <br />-20- <br />