·•'A--
LJtKE
COUNTY,
FL
REAL
FLORIDA
· REAL
CLO
SE
____________________________________
Planning and Zoning
Agent Authorization Form
I/we, (print property owner name(s)) , as the property
owner(s) of the real property described as follows, , do
hereby authorize (print agent’s name) to act as my/our
agent, to execute any petitions or other documents necessary (excluding impact fee deferral agreements) to affect
the application approval requested and more specifically described as follows,
, and to appear on my/our behalf before any administrative or legislative body in the County
considering this application and to act in all respects as our agent in matters pertaining to the application. I/we hereby
grant permission for staff to conduct a site visit in conjunction with this application.
Print Name of Property Owner
Print Name of Property Owner
State of Florida
County of Lake
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this
day of , 20_____, by
.
Personally Known OR Produced Identification
Type of Identification Produced _______________________________
(SEAL) Notary Signature
Legal Description(s), Alternate Key Number(s), or Physical Address is required:
Alternate Key or Physical Address:
NOTE: All Applications shall be signed by the Owner(s) of the Property or some person duly authorized by the Owner
to sign. The authority authorizing such person other than the Owner to sign must be attached.
Office of Planning & Zoning Revised 2020/07
Agent Authorization Form Page 1 of 1
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signature
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