DR-486a Written Authorization for Representation Before the VABMP
DR-486A
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N.01/17
WRITTEN AUTHORIZATION FOR REPRESENTATION Rule 12D-16.002
BEFORE THE VALUE ADJUSTMENT BOARD Eff. 01/17
FLORIDA 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.
CO LETED BY PETITIONER
I, (name), authorize (name) to, without compensation, act
on my behalf and present testimony and other evidence before the COLLIER El 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.
❑ 1 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
Taxpayer's/owner's phone number
Print name Date
Note: Correspondence will be sent to the mailing or email address on the petition.