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1 a s�. <br /> 4 .,� PECYAL MAGISTRATE APPLICATION <br /> INDIAN RIVER COITTY VALUE ADJUSTMENT BOARD <br /> (APPLICANTS MUST MEET QUALIFICATIONS OUTLINED IN FLA.STAT.b 194.035) <br /> 3. Have you ever been disbarred, suspended or received any bthet disciplinary action from any organized <br /> association,or from the State of Florida? ED No D Yes(please explain) <br /> 4. List any personal or business relationship you have ever bad With any macer or employee of the ofifice 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. Litt any clubs,organizations,associations,or other entities to which you belong or parttcipaae 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 /> Nona <br /> Pursuant to Fla. Staff. § 194.05,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 faxing jurisdiction,or the state?❑Yes IA No <br /> If yes,please provide details: <br /> The undersigned cettifie4, under penalty of disqualification from consideration that each item contained In this <br /> application, or any other documentfurnished by or on behalf of the applicant is true and complete as of the date it <br /> bears. The undersigned authorizes the Value Adjustment Board to obtain information/14m other sources to verify <br /> each item contained herein. The undersigned acknowledges that, (fselected,he/she willfbllow all requtrerltent,9 and <br /> Mandates of law in fuflling the duties of special magistrate. <br /> 4110 <br /> Date: 5-19-25 <br /> Signature of Applicant <br /> Terrie Peltier <br /> Printed Name of Applicant <br /> Page 3 <br /> vi)I/13/2015 <br /> -53- <br />