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57544-12 <br />FDOT RCaFWAY <br />BGG —Gdt22 <br />Florida Department of Transportation <br />RON DE.SANTIS Office of Right of Way JARED W. PERDUE, P.E. <br />GOVERNOR 3400 West Commercial Boulevard SECRETARY <br />Fart Lauderdale, FL. 33309-34,11 <br />Donation of Property to the Florida Department of Transportation <br />Indian River County <br />Attn: Richard B. Szpyrka, P.E. <br />ITEM/SEGMENT NO. <br />Public Works Director <br />MANAGING DISTRICT: <br />1801 2711, Street <br />Vero Beach. FL 32960 <br />F.A.P. NO.: <br />STATE ROAD NO.: <br />COUNTY: <br />PARCEL NO.: <br />INTEREST CONVEYED <br />4130482 <br />4 <br />D417 092 B <br />CR 6061 Oslo Road <br />Indian River <br />114 <br />Fee Simple <br />This is to advise that the undersigned, as owner of the property or property interest referenced above and as shown on <br />Right of Way maps for referenced project, desires to make a voluntary donation of said property or propery interest to the <br />State of Florida for the use and benefit of the Florida Department of Transportation. <br />The undersigned hereby acknowledges that he/she has been fully advised by a Department representative of his/her right <br />to have the referenced property or property interest appraised, to accompany the appraiser during the appraisal <br />inspection of the property, to receive full compensation for the above referenced property, and to receive reimbursement <br />for reasonable fees and costs incurred, if any. Having been fully informed of the above rights, I hereby waive those rights <br />unless otherwise noted below <br />Owner's Siqnature <br />Type or Print Property Owner's Name <br />1801 27" Street <br />Street Address <br />Vero Beach, FL 32960_ _ <br />City, State, Zip Code <br />Date <br />APPMOVEO A S "MJ f vAN <br />� U&OLEGGAL U F1 <br />i <br />P,Y <br />ttltf.t;n!,t;, 1c.B�AhL <br />155 <br />