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V&030-12 <br />RfGHT Qf WAY <br />FDOTOGC- 04Y1: <br />Florida Department of Transportation <br />ROY DESA`jTIS (bice of Ttight o€ Way JARED Y% PERDUE, P £ <br />GOVERNOR 1400 WstCo=ercialBmkvard SECRETARY <br />Fort L.der"e FL 33300 34-13 <br />Donation of Property to the Florida Department of Transportation <br />Indian River County <br />ITEM/SEGMENT NO.: <br />4130482 <br />Attn: Richard B. Szpyrka. P.E <br />—_ --- ______.__.__.__.._ <br />Public Works Director <br />MANAGING DISTRICT: <br />4 <br />1801 27" Street <br />_. <br />Vero Beacn. FL 32960 <br />F.A.P. NO.: <br />D417 092 B <br />STATE ROAD NO.: <br />CR 6061 Oslo Road <br />COUNTY: <br />Indian River <br />PARCEL NO. <br />802 <br />INTEREST CONVEYED <br />Per, etual Easement <br />This is to advise tha, the undersigned, as owner of the propery or property interest referenced above and as shown or. <br />Right of Way maps for referenced project, desires to make a voluntary donat on of said property or property interest to the <br />State of Florida for the use and benefit of the Florida Department of Trans porta tior. <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 compensaton 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 nosed below. <br />Owner's Signature <br />Type or Print Property Owners Name <br />1801 271 Street <br />Street Address <br />Vero Beach, FL 32960 <br />City, State, Zip Code <br />Date <br />APPROVED AS i�'.) F011; s <br />Anil " E AL F -o,,' <br />170 <br />