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(Revised/2012) <br />APP-REJ <br />APPLICATION FOR RELEASE OF RESERVATIONS <br />BOARD OF TRUSTEES OF THE INTERNAL IMPROVEMENT TRUST FUND <br />OF THE STATE OF FLORIDA <br />This application is to be used in order to apply for release of canal reservations, road right-of-way reservations or the release <br />of right -of -entry and exploration for oil and mineral reservations, which are reserved in favor of either the Board of Trustees <br />of the Internal Improvement Trust Fund of the State of Florida (Board of Trustees) . All applications must be submitted to <br />the following street address: DEPARTMENT ENVIRONMENTAL PROTECTION, DIVISION OF STATE LANDS, <br />BUREAU OF PUBLIC LAND ADMINISTRATION, 3800 COMMONWEALTH BOULEVARD, TALLAHASSEE, <br />FLORIDA 32399-3000, OR via email to Uniand.Annlicationsnden.state.R.us, <br />OR <br />DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />DIVISION OF STATE LANDS <br />BUREAU OF PUBLIC LAND ADMINISTRATION <br />POST OFFICE BOX 3070 <br />TALLAHASSEE, FLORIDA 32315-3070 <br />If you are applying for release of canal reservations, road right-of-way reservations or the release of right -of -entry and <br />exploration for oil and mineral reservations, which are reserved in favor of the State Board of Education, all applications <br />must be submitted to the following address: <br />FLORIDA DEPARTMENT OF EDUCATION <br />OFFICE OF GENERAL COUNSEL <br />325 WEST GAINES STREET <br />SUITE 1244 <br />TALLAHASSEE, FLORIDA 32399-0400 <br />ATTENTION: MR. STEPHEN FERST <br />If you have any questions, after reading this application form, please call (850) 245-2720 for assistance. <br />PART I: RESPOND TO ITEMS I THROUGH 6 IN THEIR ENTIRETY <br />1. TYPE OF RELEASE REQUESTED: <br />Oil and mineral reservation (Right -of -Entry and Exploration only) <br />X Road right-of-way reservation <br />_ Canal reservation <br />Corrective (Corrective releases will be processed as original applications unless an error was made by the <br />Department.) <br />2. INFORMATION FROM THE ORIGINAL DEED CONTAINING THE RESERVATION: <br />Original Deed Number(s) <br />Original Grantee <br />Date of Original Deed January19. 1944 Deed Book 35, Pane 357 <br />3. Present Owner of Record of Subject Property: Go Life Holdinq, LLC <br />4. Represented by: James W. Kem, MGR <br />Address: 305 Julia St. Phone: 386-888-7337 <br />New Smyrna Beach, FL 32168 <br />5. The subject property is located in: <br />(PLEASE SUBMIT THIS INFORMAT10AI <br />Indian Rivet County; Section 10 , Township 33 . Range 38 . Acreage (for oll/mineral) <br />6. Each application must contain the following: <br />A. A legible copy of the original deed containing the reservation. <br />b. A legible copy of present owner deed. <br />c- A current survey and a legal description of the subject property, including the Section, Township, and <br />Range. <br />(If applying for an oillindneral release, the legal description must contain acreage of tract.) <br />2 <br />Revised 08/21/12 <br />120 <br />