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G� SPECIAL: MAGISTRATE APPLICATION <br />MIAN•RIVER CO[TNTY VA�.CT ADZUSTIVIF BOARD <br />3. Have you ever been disbarred, suspended . or received tiny other disciplinary acuon iron, uuy ­ 6K <br />assotiation',-or from the State of Florida? X No CJ Yes (please explain) <br />4. List any peisonal•.of business relationship you have ever had withany officer.or employee ofAe office -of the <br />property appraiser,. office of the clerk o£ the circuit court, office of the county attorney or the'value adjustment . <br />board of any of the counties to which you are applying: <br />Nppe <br />5. List any clubs;organizations,. associations, or other emities•to which youbeIong or.psrticipate.in and in which.a <br />possibie confiici.of interest could occur'or.the. appearance of a conflict of interest might arise that would prevent <br />YOU <br />from fairly conducting the •hearing between the property appraiser and the property owner taxpayer. <br />None ' <br />i <br />Pursuant tq FIa..Stat1:-§ ].94.b35, a persoia`cannot serve 'as a special magistrate ifhe/she :is an elected or appointed <br />official of a county,;a.taxing jurisdictionOr-the 'state; is an;emoloyee,of;a county, 4 -taxing jurisdiction, or the state; <br />.servicas the Board as a special•magistrate, represents a` party before the Board hi <br />or in the same taz year that he/she <br />any administrative review of propeity.taxes. <br />Are you an elected:or appointed`ofl cial of employee of a county, a taxing jurisdiction, or. -the state? [] Yes X No <br />If yes; please provide details; , <br />i..;- . J ` than each item contained in this <br />The •undersigned,-certi�es;.under'pentiliv ofdisgualificatron from consideration,. <br />Application, or any.'oYher' document furnished by or on •behalf of the;applicdnt is true and cbmplete as of the date it <br />bears. 7We undersigned authorizes the Value Adjustment Board to vbtaih-* 0ormaYfon from other sources to verify <br />each item ;contained •herein. The undersigned acknowledges that, if selected, he/she will follow all requirements and <br />mandates of law in fu flling the duties of special magistrate. <br />Daie:` 02 <br />Piatnure of Applicant <br />Pamela B. Andrea <br />Printed Name of Applicant <br />Page,3 <br />v01/13/2015 <br />_81- <br />