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,...•' •is- ::„•:'.••••••'• <br /> • <br /> Le{'/'.' • • '�1 etjuNr ;V,AL. ? �'Y' tIOAR :;`” <br /> 1'IC:4t+T1SMIJI"fi' .. • `Alowaiii S �fi' - , _ : }' <br /> • endaii...or•received: othe�,diseiglinatj!:sc4 die y otaxad ••••,...': .` it. <br /> • • <br /> •• Have you 'dyer beon•:dispel,._sem ; <br /> • <br /> association or: oii'`the•State of Florida .4.21.$o•"Q'' •es'(iii�. l ?t�. = <br /> • <br /> • <br /> • <br /> 4.. List any persona•l ot.busifless,relationship'y•ou have ever•hail with any"officer:car•emplo}ee of the:o ce.of the <br /> `• a raiser;;oi ce of the cleric:of the.Citcitit eouri,office Of the•county attorney or the value--.•ustm:• -..' <br /> • Oro-petty . • <br /> • • •board.of any:of the coutitie .to:whichyou are applying : . <br /> • '•. S.• •List.an"club •••• ••••.:• soeiat•ions;,tirattier entitie•s :which.,yo•u b•elong or p• aiticipato.in and.in which•i:; • • <br /> • • possible conflict of interes•t coi ld:oceiir�:or-the:app:�ance of•a-¢onflict of interest.mi arise that'woul4 itevent:: : • ••• <br /> . •• <br /> you tI- n�fault+condn'eti igt(►e•licarin between the prti • tty aper seer and the• •prop ►owner. d a :. <br /> . <br /> • <br /> • <br /> • <br /> • <br /> • <br /> .•Pursuant•to Fla:Stat:.§:194,035;.asperson'cannot`seive"as_a.•spe ci�al.�magiistrate if"b she JP•.11!'elected:`or.:a iponited�'. ... • . <br /> of.ic'ial:of a county;a:taxing jurisdiction,:oe the•:s ,is"an eo}ployce of a co y,a 8: °n ii tie state;.::' <br /> .."or:incial.ee=s�ame ttaax year that -..;s�,._•,.e ,..- iyces the Board as'a special'magistrate,repretettts:a•party:before the•;Board it1;: <br /> ` - • ••-a•n•y ada• ilnist• atry ei.revieW(1f prop-_y taxeal. .. ... •"1 .. `: t. <br /> Are• <br /> .. ..:'i elected or:appointedoit cial.or eriiployee,pf a:county,s:t8xili$juiisdictlofl,ilf•the•staid?[ ,Yes" No • . <br /> : <br /> If yes,please,pr•"ovide;d'etails <br /> • <br /> • under penal '"•7' cationfrom:considertation,:'tha ' item.co stain din th .` ' <br /> e.untl signed: ti res, n . 1 . V.a1 r 4.i .�r,.,,, - .• .. • . . • <br /> : application,or any other'document f misled by`i r on beia f of the applicant'fs-tr•'r a aijd complete•us:_,,,_•,-• ,date it . • . <br /> • r <br /> bears. Tie undersigned ai tho't es the.Value Adjustment Board:to-ob ain info.' ' "`o)i other sources'to enjJi <br /> �t� <br /> • • • eachitem co»taanetf�Jiewein:. under"Bfgnedacknarvlecgges�.tht�r'•fsel.¢ctec�.h�e./sl4ewi �followtillr�rjufteiiieniis-and;• • . <br /> ..mai dates of law in.; dfrlltng:the duties,o.f s•pecial magistrate. ". • I. • <br /> ••••••%••'•r••••••••••. • .• r. . • •••••.:•• -:...,,4• •'• : ••: •.,...-;•• ;:,••••'„••baje.,•.6;:ea.9!1..::;:.,•:..,..,... •....r - -.. <br /> - Signature:ofApphca.... . ••./ • <br /> .. :" • <br /> - • - : Pamela:B:-AaidroA A.S;A:' . . . <br /> PrintedName of' iicanc <br /> . • -.95:= - •4• . :,;' • ••.• • • y• <br />