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Q <br />...SPECIAL1VIAGISTRATE APPLICA'II <br />ON <br />: <br />INDL4,N RIVER COUNTY VALUE ADJUSTMENT BOARD <br />..... <br />• ; : :: (APPLICANTS MUST: MEET QUALIFICATIONS;OUTLINED:IN&A. STAT. <br />2. Of ttio'se organizafions describe any poss <br />ilile conflict of interest that could'ohour or the appearance of a conflict' <br />of interest that may prevent you•froni fairly conducting a hearing: <br />"Non = <br />`3. Have you ever been disbarred, suspended or received any other disciplinary aciiori from any organized <br />. association; or from.the-State of Florida? X:No.:❑ Yes (please explain) <br />List any personal or business relationship you: have ever:had with any.afficer or employee of the office of the <br />propertyappraiser, office of the'elerk of the circuit court, office of the county attorney or the-value adjustirient <br />board• of any of thecounties to which you are applying: <br />.... .. None • - .. . <br />" :.:5. List any clubs, organizationsi:associations,:or other: entities to. which you belong or participate in and in which a::: <br />possible conflict of interest could occur dr the appearance of a conflict of.:interest might arise that:would prevent ' " <br />;you from:fairly conducting the hearing betweenthe property.appraiser and the'}irgperty owner and taxpayer:-: <br />uail 'Valle however, it would not -create a-conilict. In addition if ersonall know the etitioner T would <br />• <br />:.:withdraw. from the hearing . <br />Pursuant to Fla .:Stat. § :194.035, a person cannot serve as a special magistrate if helshe is an eleofed or appointed <br />official of a.county, a taxing jurisdiction;'or the state; is an employee of.a'county, a taxing juristate; or <br />diction; or the s <br />:in the same:tax year. that he/she services <br />the: <br />as a special magistrate, represents a party before the $card in any:: <br />adminisirahve review of property taxes..: <br />:Are you an elected or appointed official or employee of.a.cQunty,"a taxing <br />'urisdiction, or the state? ❑.X Yeso . <br />:If yes,'plGaje provide details: <br />The undersigned cert f es, under penalfy of disqualificatiari from consideration, .that each item contained ih this • " <br />.•ff PP p f <br />= :application; or any. -other document furnished: by or on behal o the a licant is: true and com Tete as o 'the date it <br />'bears.: 'The'undersigned authorities the Value Adjustment Board.to obtain information from-other sou'rce's to verb <br />each.item contained het cin: -The undersigned acknowledges that, if selected,. he/she will follow all requirements and <br />mandates of lacy in fu f iling the dutiQS of speciallnagist? af.- <br />..• , _ Date: 7/30l2022: • - • <br />Si ' ature of A ' licant7-4 <br />" <br />Ste hen' J. Bo le MAI " <br />Printed Name;of Applicant <br />.. .. .. .. .Page 3 <br />..: ... . ,.. • - • • .. • .... .. .. 01/131301 :.:-:' <br />