Laserfiche WebLink
m1 SPECIAL MAGISTRATE APPLICATION <br />INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD <br />(APPLICANTS MUST MEET QUALIFICATIONS IC:A7IONS OUTLINED iN DILA. S,lk 1'.'� 191 n.35) <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 ❑ 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.couuI, office of the county attorney or tine value adjustment <br />board of any of the counties to which you are applying: <br />NONE <br />5. List any dribs, organizations, associations, or other entities to which you belongs or participate in and in which.a <br />possible conflict of interest could occur or the appearance of a conflict of interest miglit arise that would prevent <br />you from fairly conducting the hearing between the property appraiser and the property owner and taxpayer. <br />NONE <br />ER T] F <br />ICA TaON' <br />Pursuant to Fla. Stat. § 194.03.5, a person .cannot serve as a special magistrate if heishe is an electedor 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 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, a taxing jurisdiction.. or the state? ❑ Yes W No <br />If yes, please provide details: <br />The undersigned.cert es,- _under penalty of disyualificatia/7 r'o!r conside!'alion, that each item contained in this <br />application, or any other dvcuiiient�iirnished ky or on, behalf c?rthe applicant is true and complete as of the date it <br />bears. Pe undersigned authorizes the Value.A4jusnuent Board to obtain infor•rrratiota rtorri other sources to verify <br />each iteimjconlained herein, The undersi�med cickrao.n ladgc�s that, if sole Ped hc'islae iuill fir}llou all regttir'Nrrlenls and <br />raandutes utirw infilftllitagg„the utr'es v pecial magistrate. , <br />.Date: <br />Signature ofAppOcan <br />_JOSEPH <br />Printed Name <br />iS, ESQUIRE <br />1'age J <br />01I1312015 <br />-23- <br />