2725 Judge Fran Jamieson Way
Building A, Room 114
Viera, Florida 32940
AUTHORIZATION TO ACT ON BEHALF OF OWNER
to act on my behalf, which may include representing me in public hearings pertaining to the
submittal of the attached application.
Choose the applicable application type. More than one may apply.
Administrative Action Comprehensive Plan Amendment
Development Plan Rezoning
State of _____________________
County of ___________________
The foregoing instrument was acknowledged before me this _____ day of ________, 20 _____
by ______________________________, who is personally known to me or has produced
_______________________________ as identification, and who did or did not take an oath.
Signature of Notary Seal: