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576-M112 <br />FDOT <br />RIGHT Of WAV <br />OW -01122 <br />Florida Department of Transportation <br />RON DESAINIIS Ofticc of Right of Wd} JARED W. PERDUE, P.E. <br />COVERVOR 341x) West C umirwroal 13.fulc%Aid SECRETARY <br />fort t judrrtiak. F1 33 N-34`1 <br />Donation of Property to the Florida Department of Transportation <br />Indian River County <br />Attn: Richard B. Szpyrka, P.E. ITEtvtlSEGMENT NO_: 4130482 <br />Public Works Drector MANAGING DISTRICT: 4 <br />1801 271` Street __ <br />Vero Beach, FL 32960 F.A.P. NO. D417 C92 B <br />STATE ROAD NO. CR 6061 Osco Road <br />COUNTY: Indian River <br />PARCEL NO.: 116 <br />INTEREST CONVEYED: 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 property interest to the <br />State of Florida for the use and benefit of the Florida Department of Transportation. <br />The undersigned hereby acknowledges that helshe 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 Signature <br />Type or Print Property Owner's Name <br />1801 271i"Street <br />Street Address <br />Vero Beach, FL 32960 <br />City, State, Zip Code <br />Date <br />APPMOVED AST 0 F05?M <br />SND L St int <br />B _ <br />byiLk.A%I1: ,-,inkt:;AhL <br />t7EPU T Y COU TY At ORNEY <br />164 <br />