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Indian River County <br />Future Land Use Map Amendment/Rezoning <br />Authorization Form <br />TO: Planning Division <br />Indian River County <br />1801 2r Street <br />Vero Beach, FL 32960 <br />FROM:. n,25 ( <br />(Property Owner) © iW <br />Property Tax I.D. #: 3 33 qo & O DOO Io /�OOODd , r] <br />3 3 0 6000,(C;/7&ooaoo/ .O <br />Property Address: _(p (o�Q /� TK . 2a-T�E� � W 3 age <br />The undersigned is hereby authorized Vt to act as agent and/or make <br />application to Indian River County for thea ove referenced property for the following applications (please <br />mark the appropriate box): <br />❑ Future Land Use Amendment <br />Rezoning <br />Owners Na e _ 'tint) Date <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />The foregoing instrument was acknowledged before me this day of <br />E7A,s r-- . 20 ,.1d by , G5m j/ -&jtJE h1gO.Owner, who is personally known tome <br />or who has produced (passport or driver's license) as identification. <br />(SEAL) NOTAR LIC: <br />Sign: <br />Printed Name: <br />Commission Number: -,VA,YPue" ATHLYN ANN FLAGG <br />Commission # GG 344371 <br />s <br />Commission Expiration: � o� Expires July B, 2023 <br />OF A hru Budget Nohry $W -s <br />FACommunity Development\APPLICATIONMcomp. Plan and Rezoning applicationslrezoningrequestform - Updated <br />2019.docx <br />32 <br />Attachment 2 <br />