HomeMy WebLinkAboutFilled Lands Affidavit- Property er Name _(Please Print) l
Prope Owner Signatfe Date.
_
STATE OF FLORIDA, COUNTY OF
AC OWLEDGED BEFORE ME THIS DAY OF F 1 ; 20
gJJ. OTSPERSONALLY KNO.WNTOME:" OR-WHOHAS-- -
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010