Fillable WRITTEN AUTHORIZATION FOR REPRESENTATION BEFORE THE VALUE ADJUSTMENT (Lake County Florida Clerk of the Circuit Court and Comptroller)

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WRITTEN AUTHORIZATION FOR REPRESENTATION BEFORE THE VALUE ADJUSTMENT (Lake County Florida Clerk of the Circuit Court and Comptroller)

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DR-486A
N. 01/17
Rule 12D-16.002
F.A.C.
Eff. 01/17
WRITTEN AUTHORIZATION FOR REPRESENTATION
BEFORE THE VALUE ADJUSTMENT BOARD
Section 194.034(1)(c), Florida Statutes
You may use this form to authorize an uncompensated representative to represent you in value
adjustment board proceedings. This form or other written authorization accompanies the petition at
the time of filing.
COMPLETED BY PETITIONER
I, (name), authorize
on my behalf and present testimony and other evidence before the
(name) to, without compensation, act
County Value Adjustment
Board.
This written authorization is effective immediately and is valid only for one assessment year.
assessment year concerning the parcel(s) or account(s) below.
This written authorization is limited to the 20
I authorize the person I appointed above to have access to confidential information related to the following
parcel(s) or account(s).
Parcel ID/Account #
Parcel ID/Account #
Parcel ID/Account #
Parcel ID/Account #
Parcel ID/Account #
Parcel ID/Account #
Parcel ID/Account #
Parcel ID/Account #
Signature of taxpayer/owner
Print name
Date
Taxpayer’s/owner’s phone number
Note: Correspondence will be sent to the mailing or email address on the petition.
LAKE
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WRITTEN AUTHORIZATION FOR REPRESENTATION BEFORE THE VALUE ADJUSTMENT (Lake County Florida Clerk of the Circuit Court and Comptroller)

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Completed 18 April 2021

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