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.