HomeMy WebLinkAboutLetter; Water Service & Sewer ServiceRETURN TO: R.N. KOBLEGARD, III,%., COURTHOUSE BOX
ANNEXATION
INDIVIDUAL
This instrument prepared by:
R. N. Koblegard, III, Esquire
200 S. Indian River Drive, Suite 201
Fort Pierce, FL 34950
Property Appraisers Parcel Identification (Folio) Number(s)
2421-802-0074-000/0
TO: WATER/WASTEWATER E
FORT PIERCE UTILITIES
POST OFFICE BOX 3191
FORT PIERCE, FLORIDA
Dear Sir:
ECEIVED
91 AUG ® 2 2011
ST. Lucie County, Permitting
EVON THAO HA, A SINGLE WOMAN
4204 ALBERFOYLE AVE
FT. PIERCE, FLORIDA 34947
AND
VANG THI PAN, A MARRIED WOMAN
5204 NW SOUTH LOVOY CIR
PORT ST. LUCIE, FLORIDA 34986, AS JOINT TENANTS WITH
RIGHT OF SURVIVORSHIP
2969 ADMIRAL STREET, FT. PIERCE, FL 34982
Location Address
4204 ALBERFOYLE AVE, FT. PIERCE, FLORIDA 34947
5204 NW S., LOWOY ST. PORT ST. LUCIE, FLORIDA 34986
Mailing Address (if different from location address)
The undersigned does hereby apply to Fort Pierce Utilities Authority for water service and/or sewer service outside the City limits of
the City of Fort Pierce, Florida to the following -described property which I own, to wit:
LOT 22 LESS THE NORTH 10 FEET AND ALL OF LOT 23, BLOCK 6, MARAVILLA PLAZA, ACCORDING TO THE PLAT THEREOF AS
RECORDED IN PLAT BOOK 5, PAGE 44, PUBLIC RECORDS OF ST. LUCIE COUNTY, FLORIDA
THE ABOVE -DESCRIBED PROPERTY IS NOT THE HOMESTEAD OF THE GRANTORS.
I hereby agree that in consideration of my request for water service and/or sewer service to my property, that if my property either
becomes contiguous to the City limits of the City of Fort Pierce, Florida, as such term is defined in the Laws of Florida, is subject to a
Chapter 171 interlocal service boundary agreement where contiguity has been waived by the County, or may otherwise be lawfully
annexed, that this application shall be considered as an application for the annexation of my above -described property into the City of
Fort Pierce, Florida, together with any real property contiguous to the above described property owned by the undersigned at the time
of signing or acquired in the future. I do also hereby for myself, my heirs, successors and assigns approve the annexation of my
property into the City of Fort Pierce, Florida and consent thereto in the event that it, or any area including it, is proposed for annexation
by election or otherwise. I waive any and all objections to annexation of the property and agree that this Agreement shall be construed
to satisfy any requirements of law for consent to, or approval of, such annexation now or hereafter required.
I further confirm that this Agreement shall be binding upon my heirs, successors or assigns and that this document may be recorded in
the Public Records of St. Lucie County, Florida for the purpose of serving as notice to all persons or entities.
In Witness Whereof, I hereunto set my hand and seal this rl day of all, 2018.
IV
SIGNED. SEALED AND DELIVERED IN OUR PRESENCE AS WITNESSES:
Signature- Evl5WTHAO HA, A SI GLE WOMAN
00/o' #
Printed Witness Signature
A t-?A &
Witness Sign re
Printed WitneAs Signature
STATE OF 6 ,10/ da "
COUNTY OF ;R-
Printed Signature
4204 Aberfovle Ave. Ft. Pierce, Florida 34947
Address
\1
Signature — VA'NG THI PAN, a married woman
Printed Signa e
5204 NW S. Lowov Cir.. Port Saint Lucie. FL 34986
Address
I hereby certify that on this day before me, an officer duly authorized to administer oaths and take acknowledgments,
personally appeared Evon Thao Ha„ a single woman and Hoa Ha and Vang Thi Pan, a married woman in whose names the
foregoing instrument was executed, and that they severally acknowledged executing the same freely and voluntarily, and that I relied
upon the following form of identification of the above -named persons: Driver's Licenses, and that an oath was not taken.
NOTARY SEAL
R
Notary Public State of Florida
Tanya Rios My Commission GG 158853
Expires 11/08/2021
witness my nana an tnclal :
aforesaid this 0771dav of
Notary Signa;
Notary Printed Sionat re
and State last
A.D.2018.