VAB SUBMITTAL AUTHORIZATION: dr486a (Written Authorization for Representation Form)DR-486A
N. 07/16
Provisional
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 sufficient written authorization should accompany
the petition at the time of filing.
COMPLETED BY PETITIONER
I, (name), authorize (name) to, without compensation, act
on my behalf and present testimony and other evidence before the County Value Adjustment
Board.
This written authorization is effective immediately and is valid only for one assessment year.
This written authorization is limited to the 20 assessment year concerning the parcel(s) or account(s)
below.
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 #
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.