Form DR-486a - New 01-17DR-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 effe ctive 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.