Special Power Of Attorney Affidavit - Corporation

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C
S
ITY OF
ARASOTA
D
A
EVELOPMENT
PPLICATION
Special Power of Attorney Affidavit - Corporation
This ______ day of ________________, ________, I, ______________________________________________
as ___________________ [title of officer] of _________________________________ [name of corporation],
a ___________________________ [state of incorporation] corporation, on behalf of the corporation as the
owner/contract purchaser [circle one] of _______________________________________________________
_______________________________________ [describe zoning lot(s) by address and tax PIN number and
attach legal description] make, constitute, and appoint ___________________________________________
of ____________________________________________ [insert address], my true and lawful attorney-in-fact,
and in my name, place and stead giving unto said ________________________________________________
full power and authority to do and perform all acts and make all representations necessary in connection
with the following Development Approval Application(s) filed with the City of Sarasota:
.
The right, powers and authority of said attorney-in-fact herein granted shall commence and be in full force
and effect on ____________________, _______, and shall remain in full force and effect thereafter until
actual notice, by certified mail, return receipt requested is received by the Office of the City Auditor and
Clerk for the City of Sarasota stating that the terms of this power have been revoked or modified.
_______________________________________
[Name of Corporation]
By: ____________________________________
[Signature]
Print Name: _____________________________
Title: ___________________________________
STATE OF FLORIDA
COUNTY OF SARASOTA
The foregoing Special Power of Attorney Affidavit was acknowledged before me this _____________ day of
______________, _______, by _____________________ [title of officer] of ___________________________
[name of corporation], on behalf of the corporation. He/she is personally known to me or has produced
__________________________________ as identification.
_______________________________________
Notary Public
State of Florida at Large
My commission expires: _____________________
Form G
December 2006

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