Form DR-486poa - New 01-17DR-486POA
N. 01/17
Rule 12D-16.002
F.A.C.
Eff. 01/17
POWER OF ATTORNEY FOR REPRESENTATION
BEFORE THE VALUE ADJUSTMENT BOARD
Section 194.034(1)(b), Florida Statutes
You may use this form to grant power of attorney for representation in value adjustment board proceedings.
This form or other power of attorney accompanies the petition at the time of filing.
COMPLETED BY PETITIONER
I, (name), appoint (name) as my attorney-in-fact to present
evidence and testimony and act on my behalf in any lawful way before the County Value
Adjustment Board.
This power of attorney is effective immediately and is valid only for one assessment year.
This power of attorney 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 #
Parcel ID/Account # Parcel ID/Account #
Parcel ID/Account # Parcel ID/Account #
This power of attorney is further limited as follows:
Signature of taxpayer/owner Print name Date
State of Florida
County of
The foregoing instrument was acknowledged before me this day of , 20 ,
by (name), who signed in
the presence of these witnesses:
Witness signature Witness signature
Personally known OR produced identification
Signature of Notary Public
Type of identification produced
Print, type, or stamp commissioned name of Notary Public