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SPECIAL MAGISTRATE APPLICATION <br /> °'I INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD <br /> (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? ©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 /> , _. ,..'I,•°,1E. w iI PVC:A T[>OxNI , !_::',:< , , ... ... <br /> , . . •- <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 patty before the Board in <br /> any administrative review of property taxes. <br /> • <br /> Are you an elected or appointed official or employee of a county,a taxing jurisdiction,or the state?0 Yes 0 No <br /> If yes,please provide•details: <br /> The undersigned certifies, under penalty of disqualifcationi from consideration, that each item contained in this <br /> application, or any other document furnished by or on behalf qf the applicant is true and complete as of the date it <br /> bears. The undersigned authorizes the Value Adjustment Board to obtain information from other sources to veil <br /> each item contained her .t. The undersigned acknowledges That, if selected, he/she will follow all requirements and <br /> mandates qf law in f mg the duties of special magistrate. <br /> — wiliNt Date: 6/1/18 <br /> •Signa re ofAp.1i,ant <br /> • <br /> St phen G. N- II <br /> Printed Name of Applicant <br /> . <br /> • <br /> Page 3 <br /> v01/13/2015 <br /> •• <br /> - 20 - <br />