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NSPECIAL-MAGISTRATE-,APPLICATION
<br />I" -1]
<br />0DJANk1W R. COUNTY VALUE ADJUSTI""
<br />BOARD
<br />.(APPLICAMS, MUST NEU QUALPICAnom
<br />QOTM 6 1,941035,1
<br />1 Ilavo you ever boog. disbarred, suspended, or'receivedany, :other: Ojs�ipjiot� action ft any n .
<br />'y organized
<br />assoeiaii6p,:..9�,#Om.the:staie,pf F16fidti?, M*Nb . ElVes. (ple'ase explaW
<br />4. List any personal or.-buginess,.relationshipgou --have ever.laad with any officer, or o.mplqyee of the officeot the
<br />propertyap0rajser, office o.f.the,clork..Pf'.ffie-,clrcul court, Wecounty attorney pi the yalav adjustment
<br />bm ' an:y.*Q."f't,b'o�cqtintlestQ*JiidhYqu,@rq-ap.P!Yi q:
<br />None
<br />5'. List0#y.qlpli4,..org#nizdtions,.associations;.-orotfier-enfitiegtowhii��._ � e ngloy-oarticipate,,in,apd-ift-which,tL
<br />I I ' . - _ ybtrb lo
<br />pos��ible.cohfl.idtdfiifti�it,�66uld-o.c.pur:ortifie:appearancem 4a*.�-'onA '��i'interi6gt-adght.4iise-thatwould.-proveni
<br />ict
<br />.yotf6nfairly coiductngthehp,mng�bDtweon,'tbc,property:qpprafser-4h..,- qpopqry'jWhergh taxP4yer.
<br />None
<br />Pursuant to PPL Stat.. § ;194.'035;.,a person canno.t: serve.as' it ispec14j.xpag4 if, he/she. is an, qlqqie�d or appointed
<br />-
<br />.
<br />dffici6l of a county, a taxfngjurisdiction; or the state; -.is,.4h pmpldygp:ofa tcoutity,..a.t=*njgjun ific'.6 14 o #r the state;.
<br />or in-ihe-sa.fiie. tax -yb4rtWb4/she services: the Board as 9rq%'tePX4s&pXs, apAr.ty-*Opfore. the Dpard.b..
<br />any adini :review-ofproperty. taxo.
<br />Are.yom,an elected or appointed-official.or omployo.of-,k,cofipAy, A taxing
<br />jurisdiction; or,-thc-state? -E1YW
<br />;,No
<br />.If yes; please PQ -,db details:
<br />4 ' ioaivn, or any. other dbeumehtjurit!Wd- 6.�;or -on:'behdffz�
<br />Zpars. The undersigned auMoHzes . . .. 1. hoa;
<br />Ady,usfinent.
<br />each item contained herein.ned.ae&owl� -
<br />The-undervig dj'- W
<br />mandWes. of.1aW-jn-fq#!1Rng,t e-iju&,v of�peoiafmagistrate
<br />Date. 411,
<br />•
<br />Temp Peltier
<br />Printed Na m -P, -.#f Applicant
<br />k—... in this
<br />f deh item C64 MW
<br />and�comoiete Z&
<br />4f4,4&t& it.
<br />P; from other sources -to. verify
<br />fll,-fQllow,,-all,reaziirementi,and
<br />'Page.$
<br />V.01/13/2015
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