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dr486a Written Authorization for Representation Before the VABDR-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.