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SPECIAL MAGISTRATE APPLICATION <br />MIAN RIVER COUNTY VALUE ADJUSTMENT BEARD <br />'4jPL[GANTS MUST MEX7 . UALlItI ATIM 0UT4KP ll+l <br />3. Have you ear been disbarred, suspended or recxivtai airy other disciplinary action fra>i y organized <br />association, or from the State of Florida? X[] No [3 Yes (please explain) <br />No <br />4. last any personal or business relationship you bane ever had with any officer or employee of the office of of the <br />property appraiser, offici of the clerk of tl!te circbit court, office of the county attordey or the value adjushnent, <br />board of any of the counties to which you are applying: <br />S. List qtly clubs, organizations, 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 cottW of interest might arise that would prevent <br />you from ffiIirly conducting the bearing between the property dw and the property owner and taxpayer. <br />pwwtmt to Fla. Stat. 0 194.035, a person cannot serve as a special magistrate if he/she is an elected or appointed <br />official of a county, a taxing jurisdiction, or the state; is an employee of a county, a taxing jurisdiction, or the stater <br />or in the same tax year that he/she services the Board as a special magistrate, represents a parry before the Hoard in <br />any administrative review of property taxes. <br />Are you an opted or appointed nfl;cW or employee of a county, a talft jurisdiction, or the state? 0 Yes X0 No <br />if yes, please provide details:........._... ...__._.._...... _ .._... �......:..._ _ ._. <br />The undersigned certtftee, under penalty of disgtrai tirnr cM0*00M that Owh ltattr eoftWned in this <br />application, or any other document furnished by or on behalf of the qMftant is trio ana! CoMPWffi as of the date it <br />bears. The undersigned authorizes theValue Adjustment Board to obtain information f om other spruces to verify <br />eavh item contained herein. 77re undersigned admowledges. that; rf selected helshe wilt fallow all requirements and <br />gradates aflaw infu#111ft the duties of special magistrate. <br />w µ Date 7/14124 <br />gnature o Ap4=t <br />Pamela B. ANIM <br />Printed Nam of Applicant <br />PW.3 <br />voiJ13J015 <br />Sl11 <br />