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Before submitting your Petition under the Indian River County Special Assessment Ordinance #81-27 to the Indian River <br />County Department of Utility Services, please ensure that you have satisfied the requirements on the following checklist <br />Do you have the Signature of 66.7% (sixty six point seven percent) of the total land owners within the <br />proposed assessment area? Yes [Z] <br />Have you supplied all the information requested on the Petition? Yes EN <br />Have you included the name, address, signature and <br />the legal description for each individual petitioner? Yes <br />Designated Individual: The individual who is designated as the official representative of the Petitioners is <br />0 t <br />Name Signature <br />Whose address is i ������' s C r u z le Se. �� <br />S4,;/.! <br />and E-mail address is O RA r,4 o s ca 63) f'o e /4 u I' . v! o f <br />Date: i 4vc4 I yl 2 o / <br />Phone No. (work): i-1 2• 5-6, J g [, n <br />lyait,z 2t141.=e-.1 <br />Phone No. (cell): % -.2 °f ` 5.6" 3 <br />