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Indian River County Property Appraiser www.ircpa.org Request for Parcel Split or Combination SPLIT E:] COMBINE PARCEL NUMBER(S) OR TAX ACCOUNT NUMBER(S) 33403000000500000009.1 33403100000100000006.1 33403100000100000003.3 33403100004000100001.0 33403100000300000001.0 Overall Site Address: 1701 Old Dixie Hwy SW *Does the request require a survey? If so, is that provided? *Does a Unity of Title exist on the parcel(s) above? Yes *If yes, has a Release of Unity of Title been recorded? Signature (Comm.Dev.Rep) M Office (County or municipality) IMPORTANT NOTICE Date Pursuant to Florida Statute 197.192, the Property Appraiser's Office will not split or combine parcels until all taxes due or delinquent have been paid to the Tax Collector. It should also be noted that a parcel split/combination by the Property Appraiser is for taxation purposes only and does not imply suitability for parcel development. Please contact the appropriate land development or planning and zoning department of your jurisdiction for questions concerning property development. HOMESTEAD/NON-HOMESTEAD PROPERTIES AFFECTED BY ASSESSMENT LIMITATION ® I/We understand that splitting or combining property may increase taxes by affecting existing capped values. If you choose to reverse the process at a future date, the cap will not be restored to its former level. PROPERTY APPRAISER TO BE HELD HARMLESS It is the responsibility of the owner to ensure all prior or current tax amounts on any parcels being split or combined with any other parcels are paid in full to the Tax Collector. This agency is not responsible for any delinquent taxes, penalties, or interest that could occur and accrue due to negligence on the part of the property owner, the owner's representatives, or other parties when requesting parcel splits or combinations. Furthermore, if the property is encumbered by a mortgage, it is the owner's responsibility to seek prior approval from the mortgage company for any changes to the property involving a split or combination. If this request is being presented by anyone other than the owner, a Power of Attorney or a Letter of Authorization from the owner must be supplied. By signing below, whether by the owner or the owner's representative, the owner acknowledges they have read and understand the aforementioned and availed themselves of the opportunity to ask any questions, seek clarification, or obtain additional information prior to this action being requested. Signature: Date: Print Name: Joseph E. Flescher, Chairman, Board of County Commissisoners of Indian River County, Florida Phone: 772-226-1244 mvietze@ircgov.com 9 Email: