Laserfiche WebLink
SPECIAL MAGISTRATE APPLICATION <br />INDIAN RIVER COUNTY VALVE ADIUSTMENT BOARD <br />(APPLICANTS MUST MWT QUALIFICATIONS C;tTlTMED Il+i 035) <br />3, Have you ever been disbarroti, suspended, or received any other disciplinary action from any organized <br />association, or from the State offlo"? A No ❑ Yes (please explain) <br />a. List any personal or business relationship you have em had with any officer or employee of the office of the <br />property appraiser, office of the clerk of the circuit c urL office of the county attorney or the value adjustment <br />board of any of the counties to which you are applying: <br />5. List any clubs, organivitions, associations, or other entities to which you belong or participate in and in which a <br />possible conflict of interest could occur or the appearance of a conflict of interest might arise that would pmvent <br />you from fairly conducting the hearing between the property appraiser and the property owner and taxpayer. <br />CERTIFICATION <br />Pursuant to. Pia. Stitt, 94.035, a person cannot serve as a special magistrate if he/she is an e'hapd or appointed <br />official of a coin, a Doing jurisdiction; or the state; is an employee of a county, a taxing jurisdiction, or the state; <br />or in thesame taxyear that he/shesetvim the Board as a special magistrate, represents a party before the Board in <br />any administrative review of property is <br />Are you an elected or appointed ofitciai or employee of a county, a taxing ju sdiction, or'the state? 17 Yes CNo <br />If yes, please provide details: <br />The undersigned cerci ex under pel by of asquakfica tion „fin, conddvwon, that each its c antalrred in dais <br />appikatinn, or any rafter dociowntfimiAed by or on beha�(� qf' * afspiicwtt:.is true and complete as of'the date it <br />bears The undersigned awtfwrizes the Value Adjustment Board to obtain information from oiter sources to verlfv <br />each itemcontained Herein. M undersigned acknowledges that, ifniected, helsshe will fallow cr l regmirements and <br />mandates of law to f t falling the duties of special niggisrrnre_ <br />c- <br />-Signature of Appy.. <br />Printed Name of Applicarit <br />Page 3 <br />v01 /13114015 <br />-9- <br />