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Indian River County <br />Future Land Use Map Amendment/Rezoning <br />Authorization Form <br />TO: Planning Division <br />Indian River County <br />1801 27'h Street <br />Vero Beach, FL 32960 <br />FROM: -S't 9M9k/A11;re-7-% 4�9fa <br />(Property Owner) J24 7 C1C&9 ^-J k70 <br />Property Tax I.D. #:0�� j Property <br />Address: Ifos, 1 , ; 11'oo dexcd/ <br />The undersigned is hereby authorized to act as agent and/or make <br />application to Indian River County for the above referenced property for the following applications (please <br />mark the appropriate box): <br />❑ Future Land Use Amendment <br />V Rezoning <br />:A kem 4. e6o9 i✓Ele I y.l <br />Owners Name (Print) <br />Owners Signature <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />iktce7 7— <br />The foregoing instrument was acknowledged before me by means of E) physical presence or E) online <br />MMI\ 20 :. Ytm <br />'x° } b y i t V aef c .r ►c <br />notarization, this C si day of _. y <br />Personally know G OR produced identification <br />(SEAL) NOTARY PUBLIC: <br />Notary Public State of Florid* <br />Amy M Tavener Sign: (,) lMAi <br />My Commission HH 524828 <br />Expires 51712028 . <br />130 <br />