Form Dr-486 - Petition To The Value Adjustment Board Request For Hearing Page 2
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2DR-486
R. 01/17
Page 2
PART 3. Taxpayer Signature
Complete part 3 if you are representing yourself or if you are authorizing a representative listed in part 5 to represent you
without attaching a completed power of attorney or authorization for representation to this form.
Written authorization from the taxpayer is required for access to confidential information from the property appraiser or tax
collector.
I authorize the person I appoint in part 5 to have access to any confidential information related to this petition.
Under penalties of perjury, I declare that I am the owner of the property described in this petition and that I have read this
petition and the facts stated in it are true.
Signature, taxpayer
Print name
Date
PART 4. Employee, Attorney, or Licensed Professional Signature
Complete part 4 if you are the taxpayer’s or an affiliated entity’s employee or you are one of the following licensed
representatives.
I am
(check any box that applies):
.
An employee of
(taxpayer or an affiliated entity)
).
A Florida Bar licensed attorney (Florida Bar number
).
A Florida real estate appraiser licensed under Chapter 475, Florida Statutes (license number
).
A Florida real estate broker licensed under Chapter 475, Florida Statutes (license number
).
A Florida certified public accountant licensed under Chapter 473, Florida Statutes (license number
I understand that written authorization from the taxpayer is required for access to confidential information from the property
appraiser or tax collector.
Under penalties of perjury, I certify that I have authorization to file this petition on the taxpayer’s behalf, and I declare that I
am the owner’s authorized representative for purposes of filing this petition and of becoming an agent for service of process
under s. 194.011(3)(h), Florida Statutes, and that I have read this petition and the facts stated in it are true.
Signature, representative
Print name
Date
PART 5. Unlicensed Representative Signature
Complete part 5 if you are an authorized representative not listed in part 4 above.
I am a compensated representative not acting as one of the licensed representatives or employees listed in part 4 above
AND (check one)
Attached is a power of attorney that conforms to the requirements of Part II of Chapter 709, F.S., executed with the
taxpayer’s authorized signature OR
the taxpayer’s authorized signature is in part 3 of this form.
I am an uncompensated representative filing this petition AND (check one)
the taxpayer’s authorization is attached OR
the taxpayer’s authorized signature is in part 3 of this form.
I understand that written authorization from the taxpayer is required for access to confidential information from the property
appraiser or tax collector.
Under penalties of perjury, I declare that I am the owner’s authorized representative for purposes of filing this petition and of
becoming an agent for service of process under s. 194.011(3)(h), Florida Statutes, and that I have read this petition and the
facts stated in it are true.
Signature, representative
Print name
Date
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