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Groveland
FLORIDA
City
with
Natural
Charm
___________________________________
________________________________
Property Owner-Agent Authorization Affidavit
Date: _________________
City of Groveland
Building Department
156 S. Lake Avenue,
Groveland, Florida 34736
Agent Authorization for the following property location: _______________________________________
To Whom it May Concern:
You are hereby advised that the undersigned is the owner of the property attached hereto.
Said owner hereby authorizes and empowers __________________________
_______________________________________ to act as agent to file application(s)
for __________________________ for the above-referenced property and in connection with
such authorization to file such applications, papers, documents, requests and other matters
necessary for such requested change.
If Owner is Individual: If Owner is Corporate Entity:*
Print Corporate Name:
By_______________________________ By ________________________________
Print Name:________________________ Print Name:_________________________
Its: ________________________________
*If Owner is Corporate Entity, please provide documentation illustrating that signatory is an authorized representative of
Owner; this may be shown through corporate resolution, power of attorney, printout from sunbiz.org, etc.
STATE OF FLORIDA
COUNTY OF LAKE
Sworn to (or affirmed) and subscribed before me this ____ day of _____ by _________________
(owner/ agent)
(Seal)
Signature of Notary Public
Personally Known:______
OR Produced Identification:_____
Type of Identification Produced:____________
revised March 12, 2020
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