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ptvErt <br /> SPECIAL MAGISTRATE APPLICATION <br /> ,• . > INDIAN RIVER COUNTY VALUE ADJUSTMENT BOARD <br /> (APPLICANTS MUST MEET QUALIFICATIONS OUTLINED IN NLA.STAT.&194.035) <br /> 3. Have you ever been disbarred, suspended or received any other disciplinary action from any organized <br /> association,or from.the State of Florida? 0 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 county attorney or the value adjustment <br /> board of any of the counties to which you are applying: <br /> NONE <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 appearance of a conflict of interest might arise that would prevent <br /> you from fairly conducting the hearing between the property appraiser and the property owner and taxpayer. <br /> NONE <br /> CERTIFICATION <br /> Pursuant to Fla. Stat. § 194.035,a person cannot serve as a special magistrate if be/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 state; <br /> or in the same tax year that he/she services the Board as a special magistrate,represents a party before the Board in <br /> any 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®No <br /> If yes,please provide details: <br /> The undersigned certifies, under penalty of disqualification from consideration, that each item contained in this <br /> application, or an,other document furnished by or on behalf'of the applicant is true and complete as of the date it <br /> bears. . ' ndersign•. authorize the Value Adjustment Board to obtain information frons other sources to verify <br /> each it n:containe, ,. a un ersigned acknowledges that, if selected,he/she will follow all requirements and <br /> mand.es ofin fidfi.ili,_ ' dull,s of special magistrate. <br /> , , Date: 5/1/2025 <br /> Sig1Sature of App <br /> OSEPH HAYNE' DAVIS, ESQUIRE <br /> tinted Name of . •plicant <br /> Page 3 <br /> v01/13/2015 <br /> -23 - <br /> 1 <br />