HomeMy WebLinkAbout249 McKay Blvd (2)`� 1f DAMIng & Mm ITT: vndon DbIssion
17 �i �C�SXDMV7Z4L MW EPF.RAOTAPPLIG4ITON
F[RE DEPARTMEl17 � n� �/ r
0/ AppHeateon No:
Documented Construction Valaw $ 0 a
Job Address: Z �I A G /4121 L3 (., Historic Didrich Yes ❑ No ❑
I'nrceim: 31-/9-
. m Review, contact Pennon: CATH ERI N E GERROL Title; ASST GM
phone: 407-542-8347 Paz: 407-366-2335 gam; catherine.gerrol@fenceoutietonline
.com
Residential Fence Information
�Type of Fens: wood Metal ❑ PVCfVinyl ❑ Iron ❑ Other ❑
rence Height: _ Feet # Gates: - Total Linear Fed- / 0 d
r
AAditional Information:
"Fences with a height of over 6 feet will require signed tit sealed Mractaral nagineeaing"
Property Owner Information
Name
Street: 2- Yq &c j i3up
I'?: - A '.. MT-N�4�1�r�
Phone:
Resident of property?
Fence Contrador Information
fame FENCE OUTLET / RAJUL PATEL
1724 W BROADWAY ST
y, Stste, Zip: OVIEDO FL 32765
Phone: 407-542-8347
Fa; 407-366-2335
Please Note: The Building Deparbnent does not perform site inspections on residential Fence
p ermat& A signed and notarrfxed Fence A, fj`YdavU is rewired to be sub along with this
�ermif applica don. Please see the attached Fence Penrnit Subiniflal Grddelinm
VARM NG TO OWNLR: YOUR FAILURE TO RECORD A NOTICE OF COA9 MMUN 'BRAY
I MULTINYOUR PAYING TWICE FORnMPROVEMNTS TO YOUR PROPERTY. A NOTICE OF
(MAMENCEMENT MUST BE RECORDED AND POEM ON THE JOB SITE BEFORE THE FIRST
MSPEC ION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LAMER OR
AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM MIMCEAHM.
Mcdvc Anpmt 1, 2017
NOTICE: In addition to the requiremems of this permit, tbere may be additional restrictions applicable to this property that may be
fi mnd in the public records of this county, and there may be additional permits required from other governmental entities such as water
management districts, state agencies, or federai agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract'is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of gubmittaL
The actrai construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. /
Sigr a of ownc/Aged Date Srgnd;; of Cwtrwtc/Agamt Date
Print Owner/Agrfs Name 7"',
Name
7
Sgvwt=ufNotaty-StMofFkmda Date S' otary of Ha ida Date
EME
crycq,UM M4 VS410
t7Q FO: Fa UEY M �
Owner/Agent is _ Personally Known to Me or C T Paw to Me or
Produced ID Type bf ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ . Electrical ❑ Mechanical ❑ Plumbing❑ Gas[:] Roof ❑
Construction Type:
Occupancy Use:
Flood Zone:
Total Sq Ft of Bldg: Agin. Occupancy Load: # of Stories:
New Construction: ElecMc - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: — UTILITIES:
rint u ha t5l►IN
ENGINEERING: FIRE:
WASTE WATER:
BUILDING:
Ok to install approx. 100linear feet of 6 foot high
privacy fence and _L_ gate(s) as shown on plan. Fence
shall be constructed with finished side facing outward.
Ravieed: J= 30, 2015 Permit Application
129/2018
SCPA Parcel View: 31-19 31527-0000-0680
Npi%
p1gpo—yrl Record Card
Parcel: 31-19.31-627-000o-owo
ti}i.ormx. Property Address: 249 MCKAY BLVD SANFORD, FL 32771
Parcel Information
Parcel
31-1931-52T-0000-D880
Owner
BIJAt i IARD, NAMME s
PMPel2y Andress
249 MCMY BLVO SANFORD, FL 32T71
Mailing
249 MCILAY BLVD SANFORD, FL 32771
Subdivision Name
I CEDAR.HILL REPEAT
TareDWct
Si-SANFORD
DOR Use Code
01SINGLE FAMILY
Exemptlaa
I OD-HOMESTEAD(2017)
a�
Y1 �
4
r^�
�xpL`a,,F2 ,.
Legal Description
LOT 88ry
CEDAR HILLREPEAT
PS 63 PGS 96 97 S 98
Taxes
Value Summary
A2018W.WN
ry2D17Certifled
Values
Values
Valuation Method
I CosUMarket
, CoWWrket
Number of BuDdtnps
Depreciated Bldg Value
$93,357
Depredated EXFr Value
i $326
Land Value (Market( ...::
°--
i30,0o0-�
-- -- —
,� $30,000
-�-- - —
Land ValueAg
,lusUMarkstValue" --
$123,682 -
i $118.301 -
Portebllity Ad(
Sava Our Hamea AdJ
r ��
i
_
_
PAO Adj
-
I ...
1 $U
Assessed Value
1$90,378 .—.(.$66,519
Ij
.`/ �+„ Tax Amaho ed wOut SOH: $1,4%.49
co 2017 Tax Bill Amount $897.68
ISave Our Hanes Savings: $50.81
Seminole Court/ GIS
` Does NOT INCLUDE Non Ad Valorem Assessments
Taxn9 Auffio&V
Assessment Value - - Exempt Values—
— Taxable Value
- --
County General Fund
$W,378 :.
W.WO 1
$40,378
...... ....._�._.. .,-.w...... ...�� _.....a
3choda
w_�-.,a,=,,....,mow,. .,.»..._.,.-.. u.,., . ,..- --,...
378 - _
m �-...»..
� 3
325 000 �-
...M. .._.
$855,378
CBySerfisrd
...__ -_$90
..
$90,378
_ .»
350,o00I
$W.378
$90.378
_...._
>R50,000
$40.378
ntY
-- --- - -
$90,378 %—
-
$SQ000 '
$40.378
Sales
Description
I Does
_
aook _.
_..1 Page
Amount Ouaww
VocAmp
WARRANTY DEED
a112o18
108762
:1/<: 0034
$124.000 Yes
Improved
�. �—
7780
j 0636
� •�•$75.00g ,Yes
SPECIAL WARRANTY DEED r,
3112011
1 07549
( 1248
$59,000 ; No _,_................„..
,_ .._
CERTIFICATE OF TrTLE
6112010i
Qj$sg
14
--- $100 1 No
I Improved -
- - -
WARRANTYDEED
-
I1111/20OG
_
Mi6
_
4944
$204000 Yes
Improved
SPECIAL WARRANTY DEED
811f2004
pOj_$120
000 I Yes
_.-.. Improved
CORRECTIVE DEED -
..... 711 . __.
7f12004
....
0..,
14@4
.F_ ....W_„. .._,....�.. .._:_.__.
., �,.,..._.... .
FVacard
_._-..__.,.___�:
WARRANTY DEED
12004
' 0
1258
$481,300 No--
j FiY1d ComgAeaLle °,aloe
Land E
Method Frontage Dapth Units Unlls Price Land Value
hftp://pare-Idetail.scpafl.org/ParceiDetailinfo.aspx?PID=311931527000006W 12
FAROUTLET Pr'opos-9" Conb-ac'
CUSTOMER
ADDRESS
*"4f4e.
PHONE: HOME 8 ' '4U I - !M -WZ W LE >Irl- (a It
fY= PROPERT" YES q� Moo O"ERS NAME
1,aWL
'pvc WOOD ALUMINUM
PVC Fed Wood Feet Aknhn Feet ❑
PC cypm COLOR Ps L) PT Pk*13 Zt Ri- El H*4 f 0 6 0 9
Height4r 01 9 0 e BOBE, ri
T&G ftacy OD Dom ❑pmkww 11 0
ftaq Wkh Lattice 13 other style Mtmkipal [] 11
Clow SW H 90 8T]
Biluko Other
M, Clow
C'da Sim Pidmt 10 [1 1'x4' [I
Runner x 4* ❑ Posit SIMB
Gate Sm Gate
Gatq— Skm— —SLE Sim
Rat ran r-1 Bel Capi 0 Sb
C -V — Stu
W. Erg. C] TOP E03 Tfadffl�iord TOP 0
c-d— in T— Dmp ni Odwo
Rmxw e)dsbg F. Ft. No I'MMAMM
13Fbillowmitourafslope
fenceline to be4lemd 4 N m Budet—jq-
Fem Line tD be Cleared by Owner
Quiet Lot Yes [I No 0
101
0 OW & Omp Bkosom Trag - G*nfo� FL 32a3Y
Talmnesi4m
1724 Wad Bmz*W 8L, Suft I OD - OWaft FL 32M
0 201 S. F&dbnbag Rind - T=Va4 FL 39919
Tel (313) 6514180
0 115V W fil" 19 - Part Rkft FL 3M
Td (nn OW-750
12984 Tudcad TmU 8. - N" Port, FL 34287
U (041) 3464800
45 G. WWW. P.0 - 0*.m FL MH
Tid (321) 904M
173 SmA Rm Rd, Unk N - Soulb DayWA FL 32119
3 Rml Fmt r CHAIN LINK
Chain Lk* Feet 'f Hetht f 0 6 0
3ReABox Haws
d 0
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Top ISBN=' Bad VMA 11
NTT
Permit Needed Yes Id No [:1
Jurisdiction te v
SpKW Intrucliom ftib 196
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41
t Outlet wffl ONW to amtmm. Mm mqvosL In dolomftno wtrme to *on is W be Waclact kd urxhw W drmmmhmm does Fa m Outlet ass = my respow1bililty cm=&T&V prop" Ibm or in
W am ttea tmwa=xmjIf propmty pft mnnot be batted, It N reowarmited ffut to amlonw haves ft property arveyocL
=0 Outlet Wm msww to m5pormbGly for bcmft unftumund and utilities, hawm, Sol Outlld Is not mponslWo for
P7gnvtimdmatftfimof—.pMm of work mid aftWMduge d 112per
% pumam mapplWID811 80=09 notpad In To.. dapsprfrtkmrs-of
pxv Ouflolt U'M pernmt In maeiu In fi& RW of access MW MMWW is 9rWW b) Fxm OutW In the eves of rmpsVnmM pm ft mmm of ON cnr*aa The cueWw agrees ID pay all kftmd and arty
bDnW 1�
lXW MINOW 10 a= the W*W ID W& Wmi or complals wok akwdy bqLn m to woo mmekk wrftcbW for, Buryw agrees b pay Sa%N 1q%iftW elmnagm of a mn mWd to 33 113% ct ardbe
, pus cost of mawkft and Wbm Wm" m In pmg� VVwnvdy may be waded oW a roomed.summ hill mopmoWts for obb*irm = assodaftn Appmmtft the too and bcOm of ftm
'M EM 19 ROMI MEMM UM MU WU UMM, FEM 98100, 09 050 GE 00 VE R@MW M FM OMM
2 01 FM 0 IM MUF 0 0 E EM IM CMID f0 FXMI M 0 Wffl. US WIM I OMO 891 0MMO OM. if
Wo 93m GO n S90HE M11 16 pu 99REM smunga C3 USE[ SOHO go Em TO OR mm 1mv
RATO RED MBOMOU= MO WO OM10 UM M VOID FEW.
92m, vo TO E 0 C WE mmin m OEM sum uni YOM =900 m a s9mma ON ONE ME 10 mi. Rmmi
TOFU RCHAS6te OF WDW FENCIM
L-W6ftnm maPmttlf RM mugb udl VA 0W*L Wood fto ho a kmdu to dutak mW vurp In hat, humid wedlmr and mal qcp wM appear bm beads &m ki tm wood as a comm ad
rctplad oc=mncL Sim Outlet vA) a* guarnlw tm mobywrAltip an wood krrors for am pm
i FIAVE READ AND UNDERSTAND THE ABOVE CLAUSE:
CONTRACTANOUNT- $ 1 APPROVED AND ACCEPTED FOR CUS702SER
0=NPAYMENT: 115D CAA—
$— CUSTOMER DA
BALANCE DUE Se Re I CUSTOMER DATE
UPON COMPLETION
ACCEPTED FOR FENCE OUTLET
q+(�
DATE STARTED DATE COMPLETED DATE
BISTALLER LABOR QUOTE VALID FOR-1-00AYS
4 L;
tij rt � S y
Building & Fire Prevention Division
SIMENTLAL FENCE AFFIODAVIT
Q (6 FEET OR LESS IN HEIGHT
PERMIT #. I $ ' C.�c� ADDRESS: CrI WD
I i.J �rT — HEREBY AFFIRM THAT ALL OF THE FOREGOING
INFORMATION IS TRUE AND ACCURATE. THE FENCE WILL BE INSTALLED IN THE APPROVED LOCATION AS SHOWN ON THE APPROVED SITE
PLAN. THE FENCE WILL BE NO HIGHER THAN 6 FEET, MEASURED FROM GRADE. THE FINISHED SIDE OF THE FENCE IS REQUIRED TO FACE
OUT. IT IS THE HOMEOWNER'S RE,SPONSIBRITY TO VERIFY THE FENCE IS PLACED WITHIN THE PROPERTY LINES AND ANY DISPUTES
BETWEEN ADJACENT HOMEOWNERS WELL BE A CIVIL. MATTER. I UNDERSTAND THAT FAIWRE TO PROPERLYNOI IOW THESE GUD7IiJ U1B5
AND ADHERE TO ALL CITY CODES ($ANFORD LAND DEVELOPMENT REGULATIONS, SCHEDULE F) COUI D RESULT TIN THE FENCE HAVA7G
TO BE REPLACED, RELOCATED OR REMOVED AT THE OWNER'S EXPENSE.
FENCE CONTRACTOR
BY SIGNING THIS AFFIDAVIT, YOU ARE ACRNOWUMGING YOU HAVE MADE THE HOMEOWNER AWARE OF TDE FENCE AFFIDAVIT
STMULATIONS AS STATED ON THIS DOCUMENT.
COMPANY/CONTRACTOR: [:to Cr- wt4j(e
CONTRACTOR SIGNATURE:
❑ HOMMMMEIt (OWNEW ILDER)
OWNER/BUHDERNAME:
OWNER / BUILDER SIGNATURE:
DATE: 0 / 1 O
DATE:
"PLEASE NOTE**
T$E BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON RESIDENTIAL FENCES. THIS
AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND WILL
SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE FENCE.
STATE OF FLORIDA COUNTY OF f Yt /np l
Sworn to and Subscribed before me this day of 201 _Qb
A.TL)_. Who is 0 Personally Known to me or has D Produced (type of
Id ca ) as identification.
S tare of Notary Public
State of Florida M'001'%28 M#H`9= +
PriitfIWe/Stamp Name
of Notary Public
Effective An" 1, 2017
BOUNDARY SURVEY
I EGAI DESCRIPTION LOT 68, CEDAR P11 I DC01 AT A/PTK1DnIAlr_ Tn TUC P1 AT '44PRFAC Ac arrrw0ED
IN PLAT 800K 63, PACE 96-98; OF
piemino Dube; apls pagsiui; ql!m pa}:)najsuo:) aq Ilegs
THE ABOVE REFERENCED PROPERTY I; aouaj •ueld uo uMogs se (s)aleg —Tpue a:)ua3 A:)enud R
F.I.R.M. COMMUNITY PANEL NO. 12117 g2lIq too; 910 laal aeauil xoadde 11exsul o} 10
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f7RST INIERNAIIONAL IIIL& INC
RDEUTY NA7I0NAL 7I7LE INSURANCE COMPANY
EQUITY PRIME MOR7G4GE
NADINE BLANCHARD
249 MCKAY BOULEVARD
LEGEND
49.� RLM CO1CKM LIgAA2;PTT
E FAST
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NOTES
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�� UEEMs oR EXCEEDS NAM MNCHARD�I T�I�ANWPLOS SQT ram 9Y MLA FMAMIWLI DAMEPURWANT ID q�pA� BT: FW& SURNET DAIffil
"' m�]7 FUNWA
CHARLES ROB DEFOORI (/L " BVSCAL LDAIS PROFESSIONAL LAND SURVEYOR � 1 OF
R 4M®B DATE IVY V1LA m E M WMACE. IDOf 114 LAW BARK MA MO RtWM DAME:
Johnson, JoAnn
From:
Johnson, JoAnn
Sent:
Monday, March 12, 2018 9:34 AM
To:
'catherine.gerrol@fenceoutletonline.com'
Subject:
Permit for 249 McKay Blvd, Issued
Attachments:
docl4098720180312095639.pdf
Receipts and required documents attached.
Thank you.
JoAnn M. Johnson
Permitting & Licensing Coordinator
Building & Fire Prevention Division
City of Sanford
300 N. Park Avenue
Sanford, FL 32771-1244
Phone: 407.688.5057
Fax: 407.688.5152
Joann.johnson@sanfordfl.gov
www.sanfordfl.gov
Out of Office Dates:
-----Original Message -----
From: joann.johnson@sanfordfl.gov[mailto:joann.johnson@sanfordfl.govj
Sent: Monday, March 12, 2018 9:57 AM
To: Johnson, JoAnn
Subject:
-------------------
CS 3051ci
[OO:cO:ee:b0:85:c1]
1
B(
LEQ& DESCRIPTION: LOT 68, CEDAR ; piem1no Dune; apis payslul; 4i!m pa1onj;suoo aq Ileys
IN PLAT BOOK 63, PAGE 96-98,' OF ' aqua; -ueld uo umoys se (s)aleg j pue aqua; A:)enud ED
y2ly boo; 9;0 laa; aeaull �� -xoadde Ilelsul of alp
aJ
THE ABOVE REFERENCED PROPERTY IS LVN n:.v 9114 cvNL A. AKLA UI' MINIMAL PLUUDINU, A5 rtR
F.I.R.M. COMMUNITY PANEL NO. 12117CO090 F. SEMINOLE COUNTY. MAP DATED SEPTEMBERR 28, 2007.
Jov
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CER77FIm Ta,
FIRST INTERNA770NAL 777L& INC.
F7DEUTY NA7IDNAL 717LE INSURANCE CAMPANY
EQUITY PRIME MORTGAGE
NADINE BLANCHARD
249 MCKAY BOULEVARD
1&GEND - NOTES
6 POAD CMXWE MOPAMIT E EW R RA= / Wft 1. EARWOS AEA: DAM CM P.ECOD FLAT
3+ fOAD PA WOM 00WIA DR ENTRANCE S WIN AE lPAQYlY SFDCW IEi M 03 DORM F f BE LEWN.
go err PROFFIRY cmIFEEe DFa eFnRe3AE sm . 3AWM Wow, Pm%= BY ME CLEM[
FLl3fAFm1f COM10.'0. Pa11r D¢R. EABFMMT aDIEDF L SCA FDOT 01S81MWS AID F== MA1i MOT FEDF UXATM
@LTA Rm TOAD ILM SDEYIMA 4. FD NRDYElWM CR IADFT161WAD UWM 181YE GEN LMTO
AQ AN 0=00 + LP. 6DM WE T TAPPOW e7Q�r AS Mum -
C{1L OLM L L cmR mm m. mEw = m me cm 'J va SRRIEY MI MOT YND U*off Dams iID sm '
LOa WOF CLAMMC m. LEMM 1 E. Typm EASF3EMf a = MO EY EI NN VAM MW AM FEA. ESTAIE MO SACMM SO DAYS
on CA oo s TElcvt am N/R "am WSC p L � R1S1t am TM W DE F H NOT A RA flW.'RF.
7. C E L1A DER L NOT Y DATE RD THE 1/1E1F8 MG.mN FG
FAUN M18 On =U-OP-PA1Y OF F&26'D.
Cti. OIA71 IACC PDI� P,C. POWT OF OIRVATIWE .1. C000 FBFCQ a 9F7ff WAY ADO®1AL AlETR =91 A1AT ARE MOT RDI09= ON ASS
C!L COA7ETE P.CF. POFMAIEER CWMX PmET na U8 TER WM PUT WAY MAY BE FORD W AE wE11C cm m Or Am COAEFY.
Cmd O TE P.T Paw Or 0. ALL � / AND OSTN:� ARE FLAT AND IRACF�/
CWL COWfER P.06 POWT Or SEID00D
CCY0.. COYO® PAL PMT OM Loa
LL P. PUT
LOMA LOT SURWf
HESFATYEY MEETS OR EkMAIM INE NCHARD HERESY
AMDARDB SET FUM BY TFE fDIAIDATIOE DATE:
ANT to PREPARED BT: I N& SEFYSY DATE
107
""°nUUM
'M SWIM 4A& CHARLES ROB DEFOOR
Z� DRASCALE DATE S-19 11-W
PROFESSIONAL LAND SURVEYOR PACE 1 Of 1
CHANIS R, allDM 4182 --- DATE 1W 11NA W EM TU&-A:{ W0T II& IAEE W . MA 3D O REVIS011 DATE:
Building & Fire Prevention Division
RMSME l 71:1ri11L FE CF, iF SL Mtn] V 111
% (6 FEET OR IX SS IN-MGHT')
PF-RMrr4jQ --S5 1 ADDRESS._ Z �? t1f 1%VD
I &Iu � V q ' C /— HEREBY AFFIRM THAT ALL of THE FOREGOING
INFORIIATIONIS TRUE AND ACCUF.ATE, THE FENCE WML BB INSTALLED IN THE APPROVED LOCATION AS SHOWN ON THE APPROVED SITE
PLAN. THE FENCE WILL BE NO HIGHER THAN 6 FEET, MEASURED FROM GRADE. THE FINISHED SIDE OF THE FhZr'CI3IS REQUIRED TO FACE
Our. IT IS THB HOMEOWNER'S RBSPONs Ban Y TO VERIFY no FENCE IS PLACED WITHIN THE PROPERTY LINKS AND ANY DISPUTES
BEIVEEN ADJACENT HOMEOWNERS WILL BE A CP'gL MATTER. I UNDERSTAND THAT PAH.URE TO PROPERLYFOLLOW THESE GUIDELLYES
AND ADHERE TO ALL CITY CODES (SANFORD LAND DEVELOPMENT REGULATIONS, SCHEDULE F) COULD RESULT INTHE FENCE HAVING
TO BE REPLACED, RELOCATED OR REMOVED ATTHE OWNER'S EXPENSE.
dF-17,CE CONTRACTOR
BY SIMIUNG nDS AFFIDAVrr, YOU ARE ACKNOWLEDGING YOTJ HAV„'+, MADE THE HOMEOWNEM AWARE OF TB-- FENCE AFFIDAVIT
STIPOLATIONS AS STATTLD ON TMS DOCUMENT.
COMPANY / CONTRACTOR: F g— Z?.MkEf
CONTRACTOR SIGNATURE: DATE:
HOINEZOWNER (OMNER/BUMDER)
OwmMMUHDER NAME:
OWNER / BUILDER SIGNAT tW: DATE:
**rLEASE NoTExz
THE BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON RESIDENTIAL FENCES. THIS
AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND V L
SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE FENCE.
STATE OF FLORIDA COUNTY OF S (— M I
Sworn to and Subscribed before me this —a— day of 20 r o by;
'\PaL) & _, Who is ❑ Personalty Known to me or bas D Produced (tyrw of
idep"catign) n _ as identification.
S nture of Notary Public CAT}$I$fi Ml
State of Florida=tYI�It�912
Emd3l�ibm SriPPds':Latn3t;a
Print/iype/Stamp Name
of Notary Public
Effect vc Ault 1, 2017