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SPECIAL MAGWRATE APPLICATION <br />INDIAN DIVER COUNTY VALUE ADJUSTMENT JUSTMENT ` ARD <br />tAPPUCAWfs Mont At Ant l a rri ' <br />3. Havc you ever been d4ibarred, trttnwadod, or r#WV4 ow stir dtsttipli y MOM fim shy m Wind <br />association. or tions the $tme of Florida" 14n E] Yst q4t6se explainl <br />4, Ust.. any personal or 1rWs ms rolatiesehip you have over had with any offs rer or orrgttoyee of the office of the <br />property appraiser', off'tc of the clerk of the circuit mart ii is of tl,,: county attorneys or the value adjustment <br />board of any of the tx►urttics to which you are aPphins. <br />None <br />5. List any clubs, organizations. Association4, ur critter etititica to which you belong or participate io,and in which a <br />possible conflict of intam wind occur or lige appouranc a of s eaorttlict of interest Fm,'gm gm asrisc that re oald pre%,cnt <br />you horn fairly amducting the hewing between the property appraiser'and the prupetty owner and taxpayer.. <br />Nana <br />Pumant to Fla. Stat ,a, 194.035; a pmon cannot serve as a special magistrao if he/she is an clectutt or appointed <br />rtflicial of a county, a taxiing juriadicticmt or the slate; is an employee of a county, a taxing jurisdictit it, 0 the state; <br />or in the same tax yea thahchbe services the Board as'a special magistrate, represents a party before the Board in <br />any adminAft0me review of pmperty taw, <br />Are you an elected ar appointed otlicial, or ern*ytd of a county, tt'tiax jurisdiction,, or the rotate' 0 Yes \e� <br />If yes, pleat/ provide details; <br />_ . .. .w <br />M undersi mcW ctr'tlfles, tenger paultv t#'diyquealifirratrean fiwm comidenation. Jlt:aat each item o,,,r,rined in this <br />application. or env odw docrern acturtrfshed kv 01'OH 6CIAdf Of the apPliC ant ix WWI and cizmpl eic err of the dare* r! <br />hem Me un&r4ped'atedier0w.t Me Value; Adju.rcer em ftoord to vlrWn h1jar»talion furor rathe4r.ta res to vedfy <br />vwc,h ide "ee►nrala aid keren. Aer r alkrs(ened acknowledges that ltsteke t�atl h&ske s4#fi2&w all requimmews and <br />mandelo r of in /eetj tlfn the dwic^s olfsperfal magisCawle. <br />t• <br />to: 8130123 <br />S€�knature of A}piicaot <br />Philicia Lloyd <br />PtintcCl Nume of Applicam <br />Pop 3 <br />011X.1015 <br />-74- <br />