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sw°`"moo, INDIAN RIVER COUNTY <br />NATURAL RESOURCES DEPARTMENT <br />1801 27th Street, Vero Beach, FL 32960 <br />SIGNATURE FORM <br />OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work <br />will be done in compliance with all applicable laws regulating <br />construction and zoning. <br />OWNER'S SIGNATURE: <br />CONTRACTOR <br />SIGNATURE: <br />Acknowledgement for Person in an Individual Capacity <br />OWNER I CONTRACTOR <br />State of Florida, County of <br />The foregoing instrument was acknowledged <br />before me by means of ❑ physical presence or ❑ <br />online notarization this day of <br />20 <br />by <br />who is ❑ personally known or ❑ produced <br />identification <br />Type of ID Produced <br />Printed Name of Notary <br />Signature of Notary <br />Notary Seal <br />State of Florida, County of <br />The foregoing instrument was acknowledged <br />before me by means of ❑ physical presence or ❑ <br />online notarization this day of <br />20 <br />by <br />who is ❑ personally known or ❑ produced <br />identification <br />Type of ID Produced <br />Printed Name of Notary <br />Signature of Notary <br />Notary Seal <br />Acknowledgement for Person in a Representative Capacity <br />OWNER I CONTRACTOR <br />State of Florida, County of <br />The foregoing instrument was acknowledged <br />before me by means of ❑ physical presence or ❑ <br />online notarization this day of <br />20 , by <br />(Name of Person) as <br />( Explain Representative Capacity) for <br />(Name of Party on <br />Behalf of Whom Instrument was Executed). <br />who is ❑ personally known or ❑ produced <br />identification <br />Type of ID Produced _ <br />Printed Name of Notary <br />Signature of Notary _ <br />Notary Seal <br />State of Florida, County of <br />The foregoing instrument was acknowledged <br />before me by means of ❑ physical presence or ❑ <br />online notarization this day of <br />20 , by <br />(Name of Person) as <br />( Explain Representative Capacity) for <br />(Name of Party on <br />Behalf of Whom Instrument was Executed). <br />who is ❑ personally known or ❑ produced <br />identification <br />Type of ID Produced _ <br />Printed Name of Notary <br />Signature of Notary <br />Notary Seal <br />