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y <br />o ; <br />SPECIAL MAGISTRATE APPLICATION ..: <br />INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD <br />(APPLICANTS MUST MEET QUALIFICATIONSDUTLINED: N FLA. STAT. a 124,031):: <br />... <br />3. IUve you ever been disbarred, suspended or received any other disciplinary action from .any organized <br />association, or from the State of Florida? ® No ❑ Yes (please explain) <br />4. List any .personal or. business relationship you have ever had with any officer or employee. of the office of the <br />property appraiser, office of the clerk of the circuit court, office of the oountyattomey or the value. adjustment, <br />board of any of:the:counties towhich you are applying: <br />None .. <br />J <br />5. List any 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 _ . prevent 1 <br />appearance of a con ict ofinterest,might arise that°would <br />you from fairly conducting the hearing between the property appraiser and the property owner and taxpayer <br />:. <br />None s <br />i. <br />Pursuant to Fla. Stat. § 194.035, a person cannot serve as a special magistrate if he/she-: is an-elected -or <br />aPPou►ted � <br />official of a county, a taxing jurisdicUon;.or the state; is an employee of a county, a taxing jurisdiction; or the state; or <br />in the same tax year that he/she services the Board as a special magistrate, represents a party before the Board in any <br />E. . <br />administrative review of property taxes. <br />.. Are you an elected or appointed official: or employee of a county, a taxing jurisdiction, or the state?:0 Yes O No i <br />Tf yes, please provide details: <br />The undersigned certfes, under penalty of disqualification from consideration, that each item''Canrtained in.this <br />application,_ or any other document, furnished by or on beha f of the applicant is. true and complete as :of the date it . <br />bears. The undersigned authorizes the Value Adjustment Board to obtain information from: other sources to verify <br />each item contained herein. the undersigned acknowledges thot, f selected he/she will fo11o►v all requirements and <br />mandates of law in fu f fling the duties of special magistrate:::.: <br />f <br />Date:5& 4 <br />:Signature of Applicant.: <br />Douglas B. Lawson, MAI <br />1 <br />.. Printed Name of Applicant . . <br />s <br />5... <br />Page 3 <br />.... v01/I31201 <br />