111 Oak View Pl - BR18-002748 - REROOFCITY OF SANFORD
JUN 1 9 201 BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Iq - 3 1i
Documented Construction Value: S 9,554.05
Job Address: 111 Oak View PI, Sanford, FL 32773 Historic District: Yes No
Parcel ID: 10-20-30-511-0000-0060 Residential x Commercial
Type of Work: New Addition Alteration Repair El Demo Change of Use Move
Description of Work: Complete Re -Roof, GAF 30 year asphalt shingle, 20 sq, 6/12 pitch
Plan Review Contact Person: Peter Arcomone Title: Production Manager
Phone: 407-677-7663 Fax: 407-677-7664 Email: Pete@jaeofamerica.com
Property Owner Information
Name Jerry Kampiyil Phone: 407-692-4271
Street: 111 Oak View PI Resident of property? : Yes
City, State Zip: Sanford, FL 32773
Contractor Information
Name JA Edwards of America, Inc Phone: 407-677-7663
Street: 220 Weber St Fax: 407-677-7664
City, State Zip: Orlando, FL 32803 State License No.: CCC05752
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: 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. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, beaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 511 Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
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NOTICE: In addition to the requirements of this permit, there may 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 co Nance with all applicable laws regulating construction and zoning.
U Qbl? - fAr"
Signature of Owner/Agent Date Signature of Contractor/Agent Date
J-trice M C,VN01er Print
Owncr/Agcnt's N c Print Co tractor/Agcni's Namc SigfiatuWU
Notary -State of Florida Date Signature of Notary -State of Florida Date o0%
f Priem LORI-ANN ARCOMONE c`f Pus,,,c
LORI-
ANN ARCOMONE Commission #
GG 107137 Commission # GG 187137 Expires
February 18, 2022 * * Expires February 18, 2022 oF
Fc°pP SWed Ttw 9udge1HWY 6-100 N
OF
FIOpP Bonded Thm eu4et Notary sonioes Owner/
Agent is Personally KnMb-LContractor/Agent is Personally Known to Me or Produced
ID _ Type of ID Produced ID Type of ID 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:
Fire
Alarm Permit: Yes No WASTE
WATER: BUILDING:
Revised:
January I, 2018 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: r)(Y1o(l'e
an agent of
Name
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 All permits and applications submitted by this contractor.
or
The specific permit and application r work located at:
Street Address)
Expiration Date for This Limited Power of AttoTey: _OU I I ;)-1 \ R
License Holder Name: %14x-C1 d L)Mnabelr State
License Number: Signature
of License H STATE
OF FLORIDA COUNTY
OF ff J
The
regoing ' strum n w s owled ed before me this < day of -j 201,
by -1 r who i ersonally known o,lj to
me or o who has produced as identification
and who did (did n take ath. Ar
nvs,c RENEE
C. COWNS commission #
GG 172M a
Expires January 7, 2022 fir!
Sign tore 0/
M1OaP eonaea rnuBudget Noauy serAmNotary
Seal)t,L%//(:di-/1 Print
or type name Notary
Public - State of 0Pvil Commission
No. 9 My
Commission Expires: 41 Z Rev.
8/06/13)
THIS INSTRUMENT PREPARED BY:
meName: 7AEdwards of rica, InC.
Address: Your Roofing Snecialistl
220 lueher Street
Orlando, FL 32803
NOTICE OF COMMENCEMENT
Permit Number.
Parcel ID Number.
l a+++ it t illit IIIII tllll IIIII Ilil IIII
GR hlT MraLOY, SEMINOLE COUNTYCLE9 . CIRCUIT COURT 1, COMF'TROLLERBK9155Ps614 (1P9s) CLERY,'S T 2018069661RECORDED06/19/2018 j9;34,5; AMRECORDINGFEES $1q.00RECORDEDBYhdevuve
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. CESCCRRIIPMON OF PROPERTY: (Legal description of the property and street address available)
2. Gr AL 6CR OF IMPROVEMENT:
3. OWNER I
Name and
Interest in
Fee Simple Title Holder (if other than owner listed above) Name:
4.
S. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number.
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section713.13(1)(a)7., Florida Statutes.
Name: Phone Number:
Address:
8. In addition, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number:
9. Expiration Date of Notice of Commencement (The expiration 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.
sl of Owner or L44we. or Owner's or Lessee's (Pdm Name and Provide Signstorys TldafOfte)
z"edd Ofter/Di f ^wner/Maneper) (/ ' / ,
QStateof \ 1 V l J X County of _ t/ \ l l J\ \
1TheforegoingInstrumentwasacknowledgedbeforemethis `2= day of
by t / 1 1J t- y \ 1 Who Is personally known to me 0 OR
Name of peXpermmng s marl
who has produced Identificatlon of Identification produced:
LORI•ANNARCOMONEo.!v"i4c
SC6mmisslon # GG 187137
m'
l Pv Expires
OTlsu84elNo"Se/vkesambed
Mdte
7"73
City of Sanford
Building and Fire Prevention
Product Approval Specification Form
Permit #
Project Location Address 111 Oak View PI, Sanford, FL 32773
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuildinQ.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal
1. Exterior Doors
Swinging
Sliding
Sectional
Roll U
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category / Subcategory Manufacturer Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles GAF Timberline FL10124-R20
Underla ments Interwrap Rhinoftof FL15216-R3
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
Category / Subcategory Manufacturer Product
Description
Florida Approval #
include decimal
S. Shutters
Accordion
Bahama
Colonial
Roll u
Equipment
Other
S. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name Gerald Laschober
Please Print)
June 2014
JA Es lwarde tvfAmerfca . lnc.
YourRb ffng5p m*dittJ
AGREEMENT SUBJECT TO INSURANCE COMPANY APPROVAL
Customer: L l'A e i Date:
Property Location: T/ Fall I Plod / Day: ( - A 71
City: Zip: Evening: — - --«
E-Mail: Vyi A an u lD GA) - C/non
ROOF SPECIFICATIONS Brand: M Style:D _ Color:
Ridge Material :R/R Valley: Open / lose Tear-O : 1 VentBox Shingle Over / Aluminum Felt. /
Ice &Water Shie Code Pltch: Story: 1 2 3 W ut: Yes / No
Roof Accessories to be replaced new and/or painted to match s ingle color.
Drop)[nstructions•
SIDING SPECIFICATIONS Brand:
Style: Straight Lap / Dutch Lap Exposure: 4" 4.5" 5" other: _
Elevation being sided (looking at house from street): Front Left
Drop Instructions:
TERMS
Style:
Back Right
Color:
Initials:
1. By signing this Agreement, you authorize JA Edwards ofAmerica Inc. to be present during the insurance adjustment and negotiate the settlement with your insurance company.
2. Unless otherwise agreed in writing, your out-of-pocket costs will be limited toyour insurance deductible amount However, you must promptly PHY JA Edwards of America Inc.
all amounts you receive from your insurance company. if you desire material upgrades or other work done on your property, you will incur additional out-of-pocket expenses.
3. This Agreement is not valid or binding on any party unless and until it is signed by both you and JA Edwards ofAmerica Inc- Once signed by you andJA Edwards ofAmerica Inc.
JA Edwards ofAmerica Inc. will be awarded with the job described above and the scope and price ofthe work will be set forth in the insurance adjuster's summary.
4. Your signature below provides your agreement to all the terms and conditions set forth on the front and back of this Agreement. Please carefully read the entire front
and back of this Agreement
5. Homeowner agrees to assignment ofbenefits to Contractor (JA Edwards ofAmerica) for payments from insurance company to
facilitate timely payments to contractor for all works approved in insurance scope.
ASSIGNMENT OF INSURANCE BENEFITS: I, the policyholder, named insured or authorized representative, hereby assign any and all insurance
benefits, rights, proceeds and any causes of action under any applicable insurance policies to JA Edwards of America for services rendered or to
be rendered by JA Edwards of America and, in the regard, waive my privacy rights. This assignment is given in consideration of JA Edwards of
America's agreement to perform services as described above, including not requiring full payment at time of service. I also hereby direct my
insurance carrier(s) to release any and all information requested by JA Edwards of America, its representative(s) and/or its attorney for the
purpose of obtaining benefits to be paid by my insurance carrier(s) for services rend9ftd or to be rendered and authorize JA Edwards and my
carrier(s) to communicate as needed with each other in this regard.
Bellev the appropriate insurance carrier is:
First Check: $ S / /
l l Check # Date
Sign r Date . '
Balance Due: $
Cheek # Date
Signature (JA Edwards ojAmerica Inc. Rep) Date Agreed Price: $ I
plus additional supplements & pet
T
fees paid by insurance company
1.10 . rll: _.__ n_J. r:l . AaS... AAY 419 9441 . C.— AM C79 9XXA . r :.......... l/"/'•!`nC'Ie'r r
SCPA Parcel View: 10-20-30-511-0000-0060 Page 1 of 2
IIA.01"", ..
U'
scwia n aouwrr, nonce
Record Card
Parcel: 10.20.30-611-0000-0060
Property Address: 111 OAK VIEW PL SANFORD, FL 32773
Value Summary
2017 Tax Bill Amount $1,601.00
Tax Estimator
Save Our Homes Savings. $1,012.00
Does NOT INCLUDE Non Ad Valorem Assessments
2016 Working 2017 Certified
Values
Valuation Method Cost/MarketMarket CosVMarket
Number of Buildings 1 1
Depreciated Bldg Value 167,624 5153,604
Depreciated EXFT Value
Land Value (Market) 536,000 1525,000
Land Value Ag
Just/Market Value " 5202,624 1$176,604
Portability Adj
Save Our Homes Adj 74,467 553,103
Amendment 1 Adj O
P8G Adj O SO
Assessed Value 126,137 125,501
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=I 0203051100000060 6/12/2018
Property
CITY OF
SA14FORD Building &Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT IS • 7:-7 4g
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: 06-12-18
CITY OF
SA14FORD
FIRE DEPARTMENT
JOB ADDRESS: 111 Oak View PI, Sanford, FL 32773
PERMIT#'Z 4g
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: ® SINGLE FAMILY RESIDENCE/rOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: OX REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): 1/2 plywood or 1 x 10 plank decking
PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED **
ROOF VENTILATION: OOFF-RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: OYES ®NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 ® 4:12 OR GREATER
TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL
SHINGLE GAF FL# 10124-R20
O METAL FL#
O MODIFIED BITUMEN FL#
OTORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES. PATIOS. ETC.) **1FAPPL/CABLE**
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#
0MODIFIED BITUMEN FL#
OTORCH DOWN FL#
O INSULATED FL#
OTILE FL#
0 OTHER: FL#
CITY OF
S ORD Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: k R -,9148 ADDRESS: 111 Oak View PI
Sanford, FL 32773
Gerald Laschober , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, 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, W ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: CCC057521
COMPANY / CONTRACTOR: JA EdWa O , nc.
CONTRACTOR SIGNATURE: DATE: (0 b 9d
MUST BE SIGNED BY LICENSE HOLDER OR OWNER/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 1 ACIC
Sworn to and Subscribed before me this day of 20 to by:
Who is 81'eisonally Known to me or has D Produced (type of
as identification.
Signature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
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