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• <br /> • <br /> (' 7;•- •01 i SPECIAL MAGISTRATE..APPLICATION • <br /> r <br /> • <br /> ' INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD i� <br /> (APPLICANTS MUST.MEET•QUALIFTATIONS OUTLINEDTN;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? ®Np la yes(please explain) <br /> 4. Listany personal:or business relationship you have ever" ad 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 anyof the counties to-which you areapplying; <br /> Applied for homestead:exemption in'the property appraisers:office In 2015. I:currantly serve as chair•to_the CAC.for•the Indian River County <br /> MPO.- <br /> . _ ., .. <br /> •5, Lisp any clubs;organizations,associatioris;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-confli.ct of interestmightarise.that would prevent <br /> you from-fairly conducting the hearing between the property-appraiser and the property owner and taxpayer. <br /> I don t belong td anycluti or organization that would preventn,e from fairly conducting.a hearing. I do belong to the.Garden Club of <br /> I'ndiari Riv.er'Caunty and the Vero Beach Country:CIUb. • <br /> • <br /> CERTIFICATION ., <br /> Pursuant:to Fla.Slat.:g 194:035;a person cannot serve as a Special Magistrate if.he/she.is.an elected or appointed <br /> official.or a,county,a•taxingjurisdiction,.or•the.state,is;an employee of a county,a:taxing.jurtsdiction,or thestate; <br /> or in the sane•'tax•year.thaAe/she services the Board as a••special.magistrate,represents-a party before the Board in <br /> any administrative review•of property taxes. <br /> Are you an.elected or appointed official or employee of a county,Ttaxing jurisdiction,or the state?❑Yes Eij No <br /> If yes,please provide details; <br /> The undersigned:certifies, under penalty of disqualification f f-am consideration, that each item contained in:this <br /> application,:a; any other document f rrnished by or on behha f e the applicant is trite and complete as•of thedate it <br /> beats. The unde/signed'.a"uthorizes the Y•alue Adjustment Board to obtain information from other solutes.to verify <br /> each itentcontained herein. the undersigned acknowledges that,,f selected,he/she will follow all requirements and <br /> mandates of law in fulfilling the ditties especial magistrate. <br /> mtatured Applica <br /> Printed Name.•of Applicant . <br /> • Page 3 <br /> w01/13/20,15 <br /> -26 - <br />