Laserfiche WebLink
SPECIAL MAGISTRATE APPLICATION <br />INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD' <br />(APPLICANTS MUST MEET QUALIMATIQNS OUTUNF.D IN +4 <br />3. Have you ever been disbarred, suspended or rectived any other disciplinary action fig+ soy organized <br />association, or from the Staw,of tea ? E No ❑ Yet (please explain) <br />4. List any personal or business relationship you have ever had with any otiitcer or employee of the office of the <br />property appraiser, office of the clerk of the circuit court, ,office of the county attorney or the value adjustment <br />board of any of the counties to which you are applying,: <br />Norm <br />5. List any clubs, organizations. associations, orotherenthiesto which you belong or partictptate in and in which a <br />possible: conflict of interest could occur or tim appearorm of atinflict of interest might arises An +end went <br />you from fairly conducting the hearing between the property and the property owner and taxpayer, <br />None <br />CERTIFICATION <br />Pursuant to Fla. Stat. $ 194,033, a pion cannot serve as a spwWl magistrate if he/she is an elected or appointed <br />official of a county, a taxing jurisdiction, or the Butte; is an. employee of a county, a taxing jurisdiction, or the state, <br />or in the same tax year that helsht services the Board as a special magistrate, represents a party bellwa the Board in <br />any administrative review of property taxes. <br />Are you an elected or appointed official or employee of a county, a terming jurisdiction, or the std"? M Yes 0 No <br />If yes, please provide details. <br />Tire unders4md certifies, under pemdty of disqudWatfon frvm consideration, that each ilei" contemned in this. <br />application, or any other aiotcun>ent furnished by or on bebWof the mpticattt is trete and cmplek as of the date it <br />bem. The untiersigned aurthorkes the F afire 44ft snnerrt Board to rabtairr fhfvrntallorr from other SoUrces to orifi, <br />each item contained herein. 77w utrdetsrigned ravknawfiedgex that, ifselected, by he ivill f blkw all) egtrir ements and <br />mandates ciflaw in fWfillurg the duties Of. ial )mVistrate. <br />t1a27't2ta#3, <br />Date <br />SoW Se9hr <br />Printed Nance of Applicant <br />-87- <br />?Me 3 <br />vOI113/2013 <br />