104 Krider Rd - BR18-002653 - REROOFCITY,OF
J,UN 12 2018 gitSO / Building c Fire Prevention Division
l'jl' - PERMIT APPLICATION
FIRE DEPARTMENT
U 1
Application No:
Documented Construction Value: $ 21,707
Job Address: 104 Krider Road, Sanford, Florida 32773 Historic District: Yes No
Parcel ID: 07-20-31-505-01300-0020 Residential Commercial
Type of Work: New[] Addition Alteration[] Repair Demo Change of Use[] Move
Description of Work: Re -Roof and Skylight (qty of 1)
Plan Review Contact Person: Missie Rubin Title: Permitting
Phone:407-960-5933 Fax:
Name Aaron Kasmir
Street: 104 Krider Road
City, State Zip:
Email: missie@xrcfl.com
Property Owner Information
Phone: 407-970-0766
Resident of property? : Yes
Sanford, Florida 32773
Name XRC, LLC
Street: 4019 W 1st Street
Contractor Information
Phone: 407-960-5933
Fax:
City, State Zip: Sanford, Florida 32771 State License No.: CCC 1329126
Architect/Engineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. 1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 1053 Shall be inscribed with the date of application and the code in effect as of that date: 01 Edition (2017) Florida Building Code
Revised: January 1, 2018 Permit Application
NOTICE: In addition to the requirements of this permit, there Imay be additional restrictions applicable to this property that may be
found 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 federal 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 submittal.
The actual 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.
51 15 ao
Signature of Owncr/Agent Date
mn osrn
Pr t wncr/Agent's Name
Ly) 5" 15 a )o
Signature of Notary -State of FI ri1TDate ddgy H-
ANN RUBIN aIlNOTARY
PUBLIC c
S STATE OF FLORIDA r ? COmrtttt
GG159793 E
19 % Expires 11 /13/2021 Owner/
Agent is Personally Known to Me or Produced
ID _ Type of 16U 10 S Large 1
1l7/aoi8 Signature
of Contractor/Agent Date Print
Contractor/Agent's Nam IL /
Iuv S i7 aol Signature
of Notary-SftfA'-Mk RUBIN Datc NOTARY
PUBLIC a —
STATE OF FLORIDA Comm#
GG159793 Expires
1/13/2021 Contractor/
Agent is Personally Known to Me or Produced
ID Type of TD BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas[-] Roof Construction
Type: Occupancy Use: Total
Sq Ft of Bldg: Min. Occupancy Load: Flood
Zone: of
Stories: New
Construction: Electric - # of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No # of Heads APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
Fire
Alarm Permit: Yes No WASTE
WATER: FIRE:
BUILDING: Revised:
January 1, 2018 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 1 a01
I hereby name and appoint:
an agent of: X 1 C, _ _L `L
Name ofCompany)
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
O The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney:,
License Holder Name:
State License Number: C, U, 3aq a
Signature of License Holder:
STATE OF FL RIDA
COUNTY OF ffdMkQ,
The foregoing instrument w#s acknowledged before me this =day of
204_a_, by who is o persona known
to me or o who has produced
identification and who did (did not) take an oath.
A" 99L-)
Signature
Notary Sea])
RUTH-ANN RUBIN Print or type name
NOTARY PUBLIC
t -STATE OF FLORIDA Notary Public - State ofComrr# GG159793
Expires 11/1793 Commission No. G
My Commission Expires: 11 1
Rev. 08.12)
as
Kd 111_ e.
n. J`
Osr-&0 G1
Xtreme
Roofing & Construction 4019
West Ist Street Sanford,
Florida 32771 Recap
by Category O&
P Items ACOUSTICAL
TREATMENTS APPLIANCES
AWNINGS &
PATIO COVERS CLEANING
CONCRETE &
ASPHALT CONTENT
MANIPULATION GENERAL
DEMOLITION DOORS
DRYWALL
ELECTRICAL
ELECTRICAL -
SPECIAL SYSTEMS FINISH
CARPENTRY / TRIMWORK HEAT,
VENT & AIR CONDITIONING INSULATION
LIGHT
FIXTURES PLUMBING
Total
723.
54 54.
79 1,
033.00 425.
89 212.
88 223.
13 5,
350.51 419.
69 1,
161.33 90.
00 89.
76 1,
470.61 225.
88 93.
13 757.
52 687.
45 TEMPORARY
REPAIRS 576.00 WINDOW
REGLAZING & REPAIR 110.43 WINDOWS -
SKYLIGHTS 561.99 WINDOW
TREATMENT 131.36 WDW
140.39 O&
P Items Subtotal Permits
and Fees Material
Sales Tax Overhead
Profit
Total
1.
47% 0.
11% 2.
10% 0.
86% 0.
43% 0.
45% 10.
87% 0.
85% 2.
36% 0.
18% 0.
18% 2.
99% 0.
46% 0.
19% 1.
54% 1.
40% 5.
28% 44.
08% 2.
29% 1.
17% 0.
22% 1.
14% 0.
27% 0.
29% 39,
974.87 81.18% 375.
00 0.76% 684.
51 1.39% 4,
103.54 8.33% 4,
103.54 8.33% 49,
241.46 100.00% The
attached estimate reflects the scope of damagebased on what could visually be seen during our assessment of thesubject property.
Any unforeseen damage will result in a change order and possible additional charges. KASMIR
3/12/2018 Page:15
Office 407-688-7405
Fax 407-688-74b8
May 24, 2018
Aaron M. Kasmir
104 Krider Rd
Sanford FL 32773
RE: 104 Krider Rd
NOTICE OF ACC APPROVAL
SANORA HOMEOWNERS ASSOCIATION
Dear Owner:
Your Request for Architectural Change as been approved. Specifically, you have approval to proceed with
the following:
Re -Roof; Owens Corning Shingles, Color - Beachwood Sand
We reserve the right to make a final inspection of the change to make sure it matches the Request you
submitted for Approval. Please follow the plan you submitted or submit an additional Request form ifyou
cannot follow the original plan.
You must follow all local building codes and setback requirements when making this change. A Building
Permit may be needed. This can be applied for at the County offices.
Our approval here is only based on the aesthetics of your proposed change. This approval should not be
taken as any certification as to the construction worthiness or structural integrity of the change you propose.
Be aware that you are responsible for contacting the appropriate Utility Companies before digging.
We appreciate your cooperation in submitting this Request for Approval. An attractive Community helps all
of us get the full value from our homes when we decide to sell.
For the Board of Directors,
Angelia L. Gordon
Angelia L. Gordon, LCAM, Community Manager
THIS INSTRUMENNT PREpARRED BY: I IliIII IIIII 1IIII iill lIII# dII I III I+lI
Name. MR__iN S
Address IwGRANT MALOY, SEMINOLE COUNTY CLERK
OF CIRCUIT COURT & COMPTROLLER Br,
9134 Ps 56 (1Pss) NOTICE
OF COMMENCEMENT CLERK'S : S66E RECORDED
05/16//16/2018 02:46:40 P11 RECORDING
FEES $10.00 State
of Florida RECORDED BY ,feckenro County
of Seminole Permit
Number: Parcel ID Number. 07-20-31-505-OB00-0020 The
undersigned hereby gives notice that Improvement will be made to certain real property, and in accordance with Chapter
713, FloridaFlriStatutes, the following InformationIsids providedinin this Nooticce orff Commencement. LV 1 ITt3LKFti,A
UNI I , KtF'LFl 1 / dF'li s1tt.avallable) C F,
AFSCRIPTION OF
IMPROVEMENT: OWNER INFORMATION: Name: AARON
M. KASMIR &
AMY M. MATTHEWS Address: 104 KRIDER ROAD,
SANFORD, FLORIDA 32773 Fee Simple Title Holder (
If other than owner) Name: Address: CONTRACTOR: Name: XRC,
LLC
Address:
4019 W 1st
STREET, SANFORD, FLORIDA 32771 Persons within the State
of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section
713.13(1)(b), Florida Statutes. Name: Address: In addition
to
himself,
Owner Designates of To receive a copy
of the Llenors Notice as Provided in Section 713.13(1)(
b), Florida Statutes. Expiration Date of Notice
of Commencement (The expiration date Is 1 year from date of recording unless a different date Is specified)
WARNING TO OWNER: ANY
PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENTS UNDER CHAPTER 713. PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST
BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalties of perjury,
I declare that I have read the foregoing and that the facts stated In It are We to the b St
of my knowledge and belief. Owners Signature Owners Printed
Name Florlds Statute M.73(
7)(9):' The owner must sign the nodce of commencement and no oneelse may be pemdded to sign In his or her stead' State of County of
The foregoing instrument was
acknowledged before mi by Name of person
making
stalwpnt OR who has produced
Identlficedon type of Identlf RUTH-ANN RUBIN NOTARY
PUBLIC STATE OF
FLORIDA 6=-
9 GG159793 Expires
11/13/2021
V
SCPA Parcel View: 07-20-31-505-0600-0020
Jonuon ip Record Card
I Parcel: 07-20.31-505-0800-0020P I Property Address: 104 KRIDER RD SANFORD, FL 32773
f I
Parcel Information Value Summary
Parcel, 07-20.31-50"B00-0020
Owners)
KASMIR, AARON M - Tenancy by Entirety
MATTHEWS, AMY M - Tenancy by Entirety
Property Address 104 KRIDER RD SANFORD, FL 32773
Mailing 104 KRIDER RD SANFORD, FL 32773
Subdivision Name SANORA UNITS 1 AND 2 REPLAT
Tax District SISANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2008)
W,
IR
Legal Description
LOT 2 BLK B
ISANDRA UNITS 1 + 2 REPLAT
PS17PG11
T s
1
0
GIS
2018 Working 1 2017 Certified
Values Values
Valuation Method Cost/Market Cost/Market -
Number of Buildings
Depredated Bldg Value 120,129 i $107,999 -
Depredated EXFT Value 2,693 2,743
Land Value (Market) 31,000 28,000
Land Value Ag
Just/Market Value- 153,822 - 138,742 -
Portability Adj
Save Our Homes Adj 63,173 49.957
Amendment 1 Adj 0
P&G Adj 0 0
Assessed Value 90,649 88.785
Tax Amount without SOH: $1,854.00
2017 Tax Bill Amount $902.00
Tax Estimator
Save Our Homes Savings: $952.00
Does NOT INCLUDE Non Ad Valorem Assessments
axe_ _ __ _ __ __ __
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 90.649 - - 50,000 - 40.649
Schools 90.649 25,000 65,649 i
City Sanford 90.649 50.000 _ 540,649
SJWM(Saint Johns Water Management) 90,649 a.848
j County Bonds - --- -- -- 90,649 _
50,000-
50.000 40.649
I
Sales
Description Date Book Page Amount Qualified VarJlmp
I WARRANTY DEED 8/1/2007 06792 0639 33,400 No Improved
i WARRANTY DEED 8/112007 0679 63 33,400 No Improved -
WARRANTY DEED - 8/1/2007 - - 06792 - 0637 33,400 No — Improved - - -
WARRANTY DEED 8/112007 06792 0636 33,400 No — Improved -
WARRANTY DEED 8/1l2007 06792 0635 33,400 • No Improved
WARRANTY DEED 8/1/2007 06792 QUA 33,400 No Improved
QUITCLAIM DEED 11/1/2005 06011 1521 100 , No Improved
WARRANTY DEED 7/1/2002 04472 0827 100 No Improved
CLAIM DEED 9/1/1995 02968 j 100 No Improved
IQUITCORRECTIVE DEED 9/1/1995 030 - 096_ 100 No Improved IIPage
1 of 2 (11 items) El] 2 1 /
2 http://parceldetail.scpafl.org/ParcelDetailinfo.aspx?PID=0720315050S00002O
5/11120T8 SCPA Parcel View: 07-20-31-505-012100-0020
I
I
Land — ---•
to Information
s eean3atn count incorrect r cncx Mere.
Description Year Built Fixtures Bed Bath Base Area Total SF Living SF Ext Well Adj Value Repl Value Appendages
Actual/Effective
1 SINGLE 1972 61 2 2.0 1,620, 2,536 ' 1,620 ; CB/STUCCO : $120.129 l $160.172 ' Description Area
FAMILY FINISH
UTILITY 152.00FINISHED
ENCLOSED
PORCH 233.00
UNFINISHED
GARAGE 506.00FINISHED
OPEN
PORCH 25.00
FINISHED
a
PemdldMdon notalgbWeham the SemWa* CountyPropwVApwmba'odllCkisd"M agWsftrat>oncgnd^ll apaM4 pMmnc*naOtMouWne tuwttnrntoru» toa = in wmcn ur wown7 to wu.
eatures
http://parceidetail.scpafl.org/PareelDetailinfo.aspx?PID=0720315050B000020 2/2
CITY .OF
SiQ Building &Fire Prevention Division
RESIDENTIAL REROOF POLICY & PROCEDURES
FIRE DEPARTMENT ' • Z3
PERMITTING REQUIREMENTS —NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING 1S REQUIRED TO BE PROVIDE ON THE JOB SITE:
PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
O EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
O ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
O ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
O UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
O DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
O DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: r1aocO
CITY OF -
S.ORD
FIRE DEPARTMENT
JOB ADDRESS: 16 4 _ VI U
PERMIT # l 5 * ?-O 53
Building A Fire Prevention Division
RESIDENTIAL RE ROOF SCOPE OF WORK
STRUCTURE TYPE: 36 SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 10 REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED**
ROOF VENTILATION: XOFF-RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: YES ONO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: FL I JV 3-
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 0 2:12 - 4:12 0 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA APPROVAL
ASHINGLE aimFL# PRODUCT106714 13
O METAL FL#
MODIFIED BITUMEN R 19
OTORCH DOWN FL#
OINSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS. ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
O SHINGLE FL#
O METAL FL#
O MODIFIED BITUMEN FL#
OTORCH DOWN FL#
O INSULATED FL#
OTILE FL#
O OTHER: FL#
CITY OF
9 S ORD Building & Fire Prevention Division
RESIDENTIAL REROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT ##: ADDRESS: O
3a-7-73
I I I luirlw-w MWWJLL i AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEW, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS - SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: C U, 1 3 Q -I I a tp
COMPANY / CONTRACTOR: X R C _ -Le,
CONTRACTOR SIGNATURE: ! DATE: 1712018
MUST BE SIGNED BY LICENSE HOLDER OR E BUILDER)
A FINAL ROOF INSPECTION IS REOUIRED:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF
Sworn to and Subscribed before me this day of 201& by:
11 Ia4y—W i-ipliQ,1.L Who is Personally Known to me or has 0 Produced (type of
id ntification) as identification.
u n Ql;d
1 RUTH-ANN RUBINSignatureofNotaryPublic
State of Florida NOTARY PUBLIC
STATE OF FLORIDA
Commit GG159793159793
Print/Type/Stamp Name
0 Expires 11/13/2021
of Notary Public