HomeMy WebLinkAboutSUBMITTED PAPERSrY
1
ALL APPLICABLE IN O 131 O PLETED FOR APPLICATION TO BE ACCEPTED �q�
Date:
SCANNED Permit Number: `—L-�G
SY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Fence
PR`OPaO"S.EDIPR'OaV�
M ANT LOCA�iT10Mi „r`k '
Address: 7402 Roberts Road
Legal Description: Lowood N6y, Lki T oc S loc-k IS Lbi 21. ' '
I
Property Tax ID #: ti r a ' I S - bdb " L Lot No. 2 I
Site Plan Name: Block No. 15
Project Name:
Setbacks Front Back: SPIT Right Side: Left Side:
Install 90 feet of 4 ft chainlink fence accross back of property'lo t easement) Install 15 feet of 4@
chainlink fence (from neighbors existing fence up property lines on both right and left sides) to be
even with back of house and then install 4@ chanlink fence from property lines (both right and left
sides) to back of house to enc�ose back yard for pets. -TIw 4t.4f,o, Ai� �r •.Wi)r) io'w_I i< 0cj.lks �',, A I r-"'10 1211 LP G I fL),RP_
Hooitionai worK to D(epertormea unaer tnis permit- ci
E1HVAC LJ Gas Tank Gas Piping
❑ Electric ❑ Plumbing Sprinklers U Generator
Total Sq. Ft of Construction: /I ��•�� S . Ft. of First Floor:
Cost of Construction: $ q '"((� 9 •U V Utilities:Sewer a Septic
au that a
Shutters
❑ Windows/Doors
Roof
Building Height.- /
7'• ry 4Y` im'i .�i Y 2�
OWNER/LESSEE
A4 ..
CONTRA�0.--T
t s:
, ....t , F
Name Iva McMullin / Marisa Buliington
Name:
Address:7402 Roberts Road
Company:
Address:
City: Fort Pierce State; F�
Zip Code: 34951 Fax:
City:
State: FI
Phone No.772-971-2016
Zip Code: Fax:
E-Mail: motonobull@gmail.com
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
State or unty License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Com ricement is required.
- Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone.
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to. do the work and installation as indicated.
1 certify thaE.no work or installatiori has, commenced prior to the issuance;of a permit
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration:of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
,in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing'a full concurrency review: room additions,
accessory structures, swimming -pools; fences, walls, signs, screen rooms and accessory uses to another non-residential use
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 jobsite.
before the first inspection.. If you intend to obtain financing, consult -with lender or an attorney before
c6lnmencing workur;KordinR your Notico of Commencement.
STATE OF FLORIDA c
COUNTY OF�-�—�
The f ing instru ent was cknowledgjjd before me
thisday: of.:- 20 ly..
A n _ 1,
(Name of person ackn
re of Nota
Personally Known _
Type of Identification
Commission No.
lublic- State of Florida )
EXPIRES: April 12, 2015
Bonded Tf S Ngtil Public Underwriters
Signature of Contractor/License Holder
STATE OF FLORIDA.
COUNTY OF
The forgoing instrument was acknowledged before me
this day.o.f 20 by
(Name of person acknowledging)
of Notary Public- State of Florida.)
Pemonally Known. OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
.REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. i/2614
k1/2014
Saint Lucie
County, Florida -
Office of the Property Appraiser
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Criteria 11 Results
�Sa�,e Detaiy Mail Labels
Records Selected: 4
3420-665-1955-000-8
Carrie J McMullin
192 SW ELDERBERRY DR
Latest Transfer: 09.11-1998 $87800
Show: Map I. Card I Trim
1301-602-01154=4
Iva M McMullin
7402 ROBERTS RD
Latest Transfer: 11-01-1987 $50400
Show: Map I Card,.1 Trim
3420-695-0834-000-0
Thomas'P McMullin
16BO SE North Blackwell Dr
Latest Transfer: 04-01-2002 $5900
. . . . . . ....
Show. Map I Card I Trim
3420-695-0633-000-1
Thomas P McMullin
1879 SE GENARO TERR
Latest Transfer: 03-19-2002 $5500
Search Property Records
MOVES,
..01,
Fporchl
10 : k� jb
F-lou�-
http://www.paslc.org /q ueryReturn:htd
M
Appi has been advised NO structures
can t e OdW* lnaMnf,;--0r-'—
right of y or
...ay uni 0
Applicant ihitWI6; v
"Ken Pruitt
Property Appraiser
r9 Cop
Py
1/1
Property Appraiser - St.Lucie Count-, -'17L
Page 1 of 1
Iva M McMullin Record: 1 of 1
Property Identification
Site Address:
7402 ROBERTS RD
SeGTown/Range:
11 :34S :39E
Map ID:
13/11S
Zoning:
RS-4
Ownership and Mailing
Owner: Iva M McMullin
Address: 7402 Roberts Rd
Fort Pierce FL 34951-1935
Sales Information
Date Price Code
11/1/1987 50400 00
6/1/1986 10000 00
PROPERTY RECORD CARD
«Prey Next» Spec.Assmnt Taxes Exemptions Permits Home Print
ParceIID: 1301-602-0115-000-4
Account* 591
Use Type: SF Res ` : •�
City/Cnty: Saint Lucie County
Legal Description
LAKEWOOD PARK -UNIT 2- BLK 15 LOT21 (MAP 13/11S) (OR 564-
1998)
Assessment 2014
Deed Book/Page 2014 TRIM: 42800
CV 0564 / 1998 Assessed: 39845
CV 0506 / 1131 Ag.Credit: 0
Exempt: 39845
Taxable: 0
Taxes: 154.13
BUILDING INFORMATION
Total Land and Building
Land Value: 6300 Acres: 0.27
Building Value: 36500
Finished Area: 984 SgFt
Exterior Features
View:
-
RoofCover:
FS - Fibrglss Shg
RoofStruct:
HP - Hip
ExtType:
HC- - HC-
YearBit:
1987
Frame:
-
Grade:
C- - C-
EffYrBlt:
1987
PrimeWall:
WS - Wood/Sheath
StoryHght:
0010 - 1 Story
No.Units:
1
SecWall:
-
Interior Features
BedRooms:
2
Electric:
MX - MAXIMUM
PrmintWall:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/Fl:
1/213ath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
CU - Carpet
%A/C:
100
%Heated:
100
%Sprinkled:
0
Special Features and
Yard Items
Land Information
Type
Y/S Qty. Units
Qual, Cond.
YrBlt. No. Use Type
Type
Measure Depth
DWC - Driv-Concret
Y 1 720
AV AV
1987 1 0100-SF Res
BI -Front Ft
90 131
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
hup://www.pasle.org/paslc/prc.asp?prclid=130160201150004 9/19/2014
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a
Friday, Sep 19, 2014 10:03 AM
l
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
,,, 89103 ( EXE P.TIONS-m
.- f
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even
though you do not have a license. You must provide direct, on -site supervision of the construction yourself. You
may build or improve farm outbuildings, a one -family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease, which is a violation of this exemption. You
may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is
your responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed
contractor who is not licensed to perform the work being done. Your construction must comply with all
laws, ordinances, building codes, and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on how to e t
the minimum code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial
I understand that if I compensate any person or company for work performed they are r quired 'to be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and li b ee
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relat i
cost, which could include loss of wages during recovery from their injury. Initial
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
M
Department to the Florida State Department of Professiona R ulation. SigneKIN,_
d acknowledged on this
day of o 20 �.' I 'V 1_n. , n tl
STATE OF FLORIDA�tis
COUNTY OFThe r gooiin strument acknowledged bef renay of ^ 20
by V�,► s personally known o me, or who has
pro uced as identif ation. n
C:k� d TAN. M A','
Signature
Title: Not
SLCPDSD Revised 05/15/2014
t Type or Pfint Name
Commission Numbi
ANGri;,ia1
AlY co"0M
Bonde- ." FlL� f
IpIV ` F : 083530
DES: Anrii i2, 2015 d 7hrti P7otwy Fub is ,0!5n;ers
(Seal)
Frr_ti'm: 08/29/2014 ",39 #526 P.001/011
TO:
BARKLEY
INTERNATIONAL
DESIGN GROUP, INC.
FACSIMILE TRANSMITTAL SHEET
If you do not receive all the pages listed, please contact me. Thank you.
FROM:
Marisa CM91
DATE: -
FAX NUMBER: TOTAL NO. OF PAGES INCLUDIN C
� -1 a - � �+OVER:
PHONE NUMBER: RE:
.N
t
❑ PERSONAL & CONFIDENTIAL ❑ URGENT ❑ PLEASE REVIEW ❑ PLEASE REPLY
t.J
e INTERNATIONAL DESIGN GROUP
Barkley Construction Inc.
ROOM / DESIGN CENTER / OFFICE:
Vero Beach, FL 32960 Tel: 772-564-9099 Fax: 772-564-9499
WAREHOUSE (by appointrncnt only):
682 Old Dixie Hwy, Vero Beach, F132967
cs@barkleyintcom LIC#IB 0000755
From: 08/29/2014 ",39 #526 P.002/011
DURABLE POWER OF ATTORNEY
1, TVA M. MCMULLIN, my address being 7402 Roberts Rd, Fort Pierce, Florida 34951,
make, constitute and appoint my daughter, MARISA D. MCMULLIN-BULLINGTON, as my
attorney in fact and agent. If MARISA D. MCMULLIN-BULLINGTON, dies, becomes legally
disabled, resigns, or refuses to act, I appoint my granddaughter, JULIA G. EVANS, as my attorney in
fact and agent. ,
ARTICLE I
I hereby give and grant unto my said agent full power and authority to act for me in any
lawful way with respect to the powers enumerated in Article 11, and to the powers which I have
initialed in Article M, of this durable power of attorney.
ARTICLE II
My agent is authorized to act for me in my name, place and stead and may exercise any or
all of the powers contained in this Article H.
221 Banking and Other Financial Institution Transactions. With regard to
bankini and other financial institution transactions, my agent shall have the authority to conduct
banking transactions as provided in section 709.2208(1), Florida Statutes. In addition, my agent
is authorized to enter into an existing safe-deposit box, may deposit items or withdraw items
therefrom, and may also terminate the contract for such safe-deposit box.
2,_2 Investment Transactions. With regard to stock and bond transactions, my agent
shall have the authority to conduct investment transactions as provided in section 709.2208(2),
Florida Statutes.
2_3 Real Property Transactions. With regard to real property transactions, my agent
may exercise all of the following powers with regard to any real property I own: (1) convey or
mortgage homestead property; (2) accept as a gift or as security for a loan or reject demand, buy,
lease, receive, or otherwise acquire an interest in real property or a right incident to real property;
(3) sell, exchange, convey with or without covenants, quitclaim, release, surrender, mortgage,
encumber, partition, consent to partitioning, subdivide, apply for zoning, rezoning, or other
governmental permits, plat or consent to platting, develop, grant options concerning, lease or
sublet, or otherwise dispose of an estate or interest in real property or a right incident to real
property; (4) release, assign, satisfy, and enforce by litigation, action, or otherwise a mortgage,
deed of trust, encumbrance, lien, or other claim to real property that exists or is claimed to exist;
(5) do any act of management or of conservation with respect to an interest in real property, or a
right incident to real property, owned or claimed to be owned by me, including power to insure
against a casualty, liability, or loss; obtain or regain possession or protect the interest or right by
litigation, action, or otherwise; pay, compromise, or contest taxes or assessments or apply for and
receive refunds in connection with them; and purchase supplies, hire assistance or labor, or make
FrOm: 08/29/2014,'-"l-A #526 P.0031011
repairs or alterations in the real property; (6) use, develop, alter, replace, remove, erect, or install
structures or other improvements on real property in which I have or claim to have an estate,
interest, or right; (7) participate in a reorganization with respect to real property or a legal entity
that owns an interest in or right incident to real property, receive and hold shares of stock or
obligations received in a plan or reorganization, and act with respect to the shares or obligations,
including selling or otherwise disposing of the shares or obligations; exercising or selling an.
option, conversion, or similar right with respect to the shares or obligations; and voting the
shares or obligations in person or by proxy; (8) change the form of title of an interest in or right
incident to real property; and (9) dedicate easements or other real property in which I have or
claim to have an interest to public use, with or without consideration.
2�4 Tangible Personal Property Transactions. With regard to tangible personal
property transactions, my agent may exercise all of the following powers: (1) accept as a gift or
as security for a loan, reject, demand, buy, receive, or otherwise acquire ownership or possession
of tangible personal property or an interest in tangible personal property; (2) sell, exchange,
convey with or without covenants, release, surrender, mortgage, encumber, pledge, hypothecate,
create a security interest in, pawn, grant options concerning, lease or sublet to others, or
otherwise dispose of tangible personal property or an interest in tangible personal property; (3)
release, assign, satisfy, or enforce by litigation, action, or otherwise a mortgage, security interest,
encumbrance, lien, or other claim on my behalf, with respect to tangible personal property or an
interest in tangible personal property; and (4) do an act of management or conservation with
respect to tangible personal property or an interest in tangible personal property on my behalf,
including insuring against casualty, liability, or loss; obtaining or regaining possession or
protecting the property or interest by litigation, action, or otherwise; paying, compromising, or
contesting taxes or assessments or applying for and receiving refunds in connection with taxes or
assessments; moving from place to place; storing for hire or on a gratuitous bailment; and using,
altering, and making repairs or alterations.
2_5 Business Operation Transactions. With regard to business operation
transactions, my agent may exercise all of the following powers: (1) operate, buy, sell, enlarge,
reduce, or terminate a business interest; (2) to the extent that my agent is permitted by law, to
perform a duty or discharge a liability or exercise a right, power, privilege, or option that I have,
may have, or claim to have under a partnership agreement, whether or not I am a general or
limited partner; (3) to the extent that my agent is permitted by law, to enforce the terms of a
partnership agreement by litigation, action, or otherwise; (4) to the extent that my agent is
permitted by law, to defend, submit to arbitration, settle, or compromise litigation or an action
to which I am a party because of membership in the partnership; (5) exercise in person or by
proxy or enforce by litigation, action, or otherwise a right, power, privilege, or option I have or
claim to have as the holder of a bond, share, or other instrument of similar character and defend,
submit to arbitration, settle, or compromise a legal proceeding to which I am a party because of a
bond, share, or similar instrument; (6) with respect to any business owned solely by me,
continue, modify, renegotiate, extend, and terminate a contract made with any individual or legal
entity, firm, association, or corporation by or on my behalf with respect to the business before
execution of the power of attorney; (7) with respect to any business owned solely by me, to
2
Fr6m: 08/29/2014 '",40 #526 P.0041011
determine the location of its operation; the nature and extent of its business; the methods of
manufacturing, selling, merchandising, financing, accounting, and advertising employed in its
operation; the amount and types of insurance carried; and the mode of engaging, compensating,
and dealing with its accountants, attorneys, and other agents and employees; (8) with respect to
any business owned solely by me, to change the name or form of organization under which the
business is operated and enter into a partnership agreement with other persons or organize a
corporation to take over all or part of the operation of the business; (9) with respect to any
business owned solely by me, to demand and receive money due or claimed by me or on my
behalf in the operation of the business and control and disburse the money in the operation of the
business; (10) put additional capital into a business in which I have an interest; (11) join in a plan
of reorganization, consolidation, or merger of the business; (12) sell or liquidate a business or
part of it at the time and on the terms that my agent considers desirable; (13) establish the value
of a business under a buy-out agreement to which I am a party; (14) prepare, sign, file, and
deliver reports, compilations of information, returns, or other papers with respect to a business
that are required by a governmental agency, department, or instrumentality or that my agent
considers desirable and make related payments; and (15) pay, compromise, or contest taxes or
assessments and do any other act that my agent considers desirable to protect me from illegal or
unnecessary taxation, fines, penalties, or assessments with respect to a business, including
attempts to recover, in any manner permitted by law, money paid before or after the execution of
the power of attorney.
226 Insurance Transactions. With regard to insurance transactions, my agent may
exercise all of the following powers: (1) continue, pay the premium or assessment on, modify,
rescind, release, or terminate a contract procured by or on my behalf that insures or provides an
annuity to either me or another person, whether or not I am a beneficiary under the contract; (2)
procure new, different, or additional contracts of insurance and annuities for me or my children,
and other dependents and select the amount, type of insurance or annuity, and mode of payment;
(3) pay the premium or assessment on or modify, rescind, release, or terminate a contract of
insurance or annuity procured by my agent; (4) apply for and receive a loan on the security of the
contract of insurance or annuity; (5) surrender and receive the cash surrender value of a contract
of insurance or annuity; (6) exercise an election; (7) change the manner of paying premiums; (8)
change or convert the type of insurance contract or annuity with respect to which I have or claim
to have a power described in this section; (9) apply for and procure government aid to guarantee
or pay premiums of a contract of insurance on my life; (10) collect, sell, assign, hypothecate,
borrow on, or pledge my interest in a contract of insurance or annuity; and (11) pay from
proceeds or otherwise, compromise or contest, or apply for refunds in connection with a tax or
assessment levied by a taxing authority with respect to a contract of insurance or annuity or its
proceeds or liability accruing because of the tax or assessment.
2_7 . Estate, Trust, and Other Beneficiary Transactions. With regard to estate,
trust, and other beneficiary transactions, my agent may act for me in all matters that affect a trust,
probate estate, guardianship, conservatorship, escrow, custodianship, or other fund from which I
am, may become, or claim to be entitled, as a beneficiary, to a share or payment, including to: (1)
accept, reject, disclaim, receive, receipt for, sell, assign, release, pledge, exchange, or consent to
From: 08/29/2014 /^, 4O #526 P.005/011
a reduction in or modification of a share in or payment from the fund; (2) demand or obtain by
litigation, action, or otherwise money or any other thing of value to which I am, may become, or
claim to be entitled because of the fund; (3) initiate, participate in, or oppose a legal or judicial
proceeding to ascertain the meaning, validity, or effect of a deed, will, declaration of trust, or
other instrument or transaction affecting my interest; (4) initiate, participate in, or oppose a legal
or judicial proceeding to remove, substitute, or surcharge a fiduciary; (5) conserve, invest,
disburse, or use anything received for an authorized purpose; and (6) transfer all or part of my
interest in real property, stocks, bonds, accounts with financial institutions, insurance, and other
property to the trustee of a revocable trust created by me as settlor.
228 Claims and Litigation. With regard to claims and litigation, my agent has the
power to: (1) assert and prosecute before a court or administrative agency a claim, a claim for
relief, a counterclaim, or an offset or defend against an individual, a legal entity, or a
government, including suits to recover property or other thing of value, to recover damages
sustained by me, to eliminate or modify tax liability, or to seek an injunction, specific
performance, or other relief; (2) bring an action to determine adverse claims, intervene in an
action or litigation, and act as amicus curiae; (3) in connection with an action or litigation,
procure an attachment, garnishment, libel, order of arrest, or other preliminary, provisional, or
intermediate relief and use an available procedure to effect or satisfy a judgment, order, or
decree; (4) in connection with an action or litigation, perform any lawful act I could perform,
including acceptance of tender, offer of judgment, admission of facts, submission of a
controversy on an agreed statement of facts, consent to examination before trial, and binding of
me in litigation; (5) submit to arbitration, settle, and propose or accept a compromise with
respect to a claim or litigation; (6) waive the issuance and service of process on me, accept
service of process, appear for me, designate persons on whom process directed to me may be
served, execute and file or deliver stipulations on my behalf, verify pleadings, seek appellate
review, procure and give surety and indemnity bonds, contract and pay for the preparation and
printing of records and briefs, or receive and execute and file or deliver a consent, waiver,
release, confession of judgment, satisfaction of judgment, notice, agreement, or other instrument
in connection with the prosecution, settlement, or defense of a claim or litigation; (7) act for me
with respect to bankruptcy or insolvency proceedings, whether voluntary or involuntary,
concerning me or some other person, with respect to a reorganization proceeding or a
receivership or application for the appointment of a receiver or trustee that affects my interest in
real or personal property or other thing of value; and (8) pay a judgment against me or a
settlement made in connection with a claim or litigation and receive and conserve money or other
thing of value paid in settlement of or as proceeds of a claim or litigation.
2_9 Personal and Family Maintenance. With regard to personal and family
maintenance, my agent may exercise all of the following powers: (1) perform the acts necessary
to maintain the customary standard of living of me and my children, and other individuals
customarily or legally entitled to be supported by me, including providing living quarters by
purchase, lease, or other contract, or paying the operating costs, including interest, amortization
payments, repairs, and taxes on premises owned by me and occupied by those individuals; (2)
provide for the individuals described by Subsection (1) of this section normal domestic help,
4
From: 08/29/2014 19,41 #526 P.006/011
usual vacations and travel expenses, and funds for shelter, clothing, food, appropriate education,
and other current living costs; (3) pay necessary medical, dental, and surgical care,
hospitalization, and custodial care for the individuals described by Subsection (1) of this section;
(4) continue any provision made by me for the individuals described by Subsection (1) of this
section., for automobiles or other means of transportation, including registering, licensing,
insuring, and replacing the automobiles or other means of transportation; (5)-maintain or open
charge accounts for the convenience of the individuals described by Subsection (1) of this section
and open new accounts that my agent considers desirable to accomplish a lawful purpose; and (6)
continue payments incidental to my membership or affiliation in a church, club, society, order, or
other organization or to continue contributions to those organizations.
2.10 Benefits From Certain Governmental Programs or Civil or Military Service.
With regard to benefits from social security, Medicare, Medicaid, or other governmental
programs or civil or military service, my agent has the power to: (1) execute vouchers in my
name for allowances and reimbursements payable by the United States, a foreign government, or
a state or subdivision of a state to me, including allowances and reimbursements for
transportation of the individuals described by Section 2.09(1) of this durable power of attorney,
and for shipment of their household effects; (2) take possession and order the removal and
shipment of my property from a post, warehouse, depot, dock, or other place of storage or
safekeeping, either governmental or private, and execute and deliver a release, voucher, receipt,
bill of lading, shipping ticket, certificate, or other instrument for that purpose; (3) prepare, file,
and prosecute a claim to a benefit or assistance, financial or otherwise, to which I claim to be
entitled under a statute or governmental regulation; (4) prosecute, defend, submit to arbitration,
settle, and propose or accept a compromise with respect to any benefits I may be entitled to
receive; and (5) receive the financial proceeds of a claim of the type described in this Section
2.10 of this durable power of attorney and conserve, invest, disburse, or use anything received for
a lawful purpose.
2. 11 Retirement Plan Transactions. With regard to retirement plan transactions, my
agent may exercise all of the following powers: (1) apply for service or disability retirement
benefits; (2) select payment options under any retirement plan in which I participate, including
plans for self-employed individuals; (3) make voluntary contributions to retirement plans if
authorized by the plan; (4) exercise the investment powers available under any self -directed
retirement plan; (5) make "rollovers" of plan benefits into other retirement plans; (6) borrow
from, sell assets to, and purchase assets from retirement plans if authorized by the plan; (7) waive
my right to be a beneficiary of a joint or survivor annuity if I am an unemployed spouse; (8)
receive, endorse, and cash payments from a retirement plan; (9) waive my right to receive all or a
portion of benefits payable by a retirement plan; and (10) request and receive information
relating to me and my retirement plan records.
2.12 Tax Matters. With regard to tax matters, my agent may exercise all of the
following powers: (1) prepare, sign, and file federal, state, local, and foreign income, gift,
payroll, Federal Insurance Contributions Act, and other tax returns, claims for refunds, requests
for extension of time, petitions regarding tax matters, and any other tax -related documents,
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including receipts, offers, waivers, consents, including consents and agreements under Section
2O32A of the Internal Revenue Code of 1986, as amended, (the "Code"), closing agreements, and
any power of attorney form required by the Internal Revenue Service or other taxing authority
with respect to a tax year on which the statute of limitations has not run and 25 tax years
following that tax year; (2) pay taxes due, collect refunds, post bonds, receive confidential
information, and contest deficiencies determined by the Internal Revenue Service or other taxing
authority; (3) exercise any election available to me under federal, state, local, or foreign tax law;
(4) act for me in all tax matters for all periods before the Internal Revenue Service and any other
taxing authority; and (5) represent me, and appoint an agent or agents to represent me, before the
Internal Revenue Service or any State or other taxing authority by completing, signing, and
submitting IRS Form 2848 or any other governmental form.
2.13 Existing and Foreign Interests. The powers described in Article II of this
durable power of attorney may be exercised equally with respect to an interest I have at the time
this durable power of attorney is executed or an interest which I acquire later, whether or not the
interest is located in Florida and whether or not the powers are exercised or the durable power of
attorney is executed in Florida.
ARTICLE III
My agent is authorized to perform the following specific acts for me if I have initialed the
specific authority listed below -
Initial:
es No Power to Make Gifts. I grant to my agent the power to make gifts of any of my
property to or to pay amounts on behalf of (including transfers which are made
outright, in trust or otherwise) any one or more of my descendants (including my
agent, if my agent is a descendant of mine) or to any charitable organization to
which deductible gifts may be made under the income and gift tax provisions of
the Code. Such gifts or amounts paid to my descendants shall include those
which are excludible under Section 25O3(b) or Section 25O3(e) of the Code or
those to which the split gift provisions of Section 2513 of the Code are expected
to apply. Nothing herein shall be construed to require any court action
whatsoever prior to making such gifts, nor to restrict such gifts to a situation in
which it must be determined that I will remain incapacitated for the remainder of
my lifetime. Notwithstanding the foregoing, the gifts made by a person who is
serving as my agent under this durable power of attorney to himself or herself
shall not exceed in the aggregate for any calendar year the greater of five thousand
dollars ($5,000) or five percent (5%) of the fair market value of my estate (for
U.S. gift tax purposes) as of December 31st of such calendar year; provided,
however, if my agent is making gifts authorized by the following paragraph of this
durable power of attorney in order to obtain or maintain eligibility for public
health care benefits, then these limitations shall not apply.
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08/29/2014 `.42 #526 P.0081011
G
No Power to Make Gifts to Qualify for Public Benefits. If my agent in my agent's
sole discretion has determined that I need nursing home or other long-term
medical care and that I will receive proper medical care whether I privately pay
for such care or if I am a recipient of Title XIX (Medicaid) or other public
benefits, then my agent shall have the power: (1) to take any and all steps
necessary, in my agent's judgment, to obtain and maintain my eligibility for any
and all public benefits and entitlement programs, including, if necessary, creating
and funding a qualified income trust or special needs trust for me, or a disabled
child, if any; (2) to transfer with or without consideration my assets to my
descendants (if any), or to my natural heirs at law or to the persons named as
beneficiaries under my last will and testament or a revocable living trust which I
may have established, including my agent; and (3) to enter into a personal services
contract for my benefit, including entering into such contract with my agent, and
even if doing so may be considered self -dealing. Such public benefits and
entitlement programs shall include, but are not limited to, Social Security,
Supplemental Security Income, Medicare, Medicaid and Veterans benefits.
(Ye No Create an Intervivos Trust. I grant to my agent the power to create for me one or
.� more revocable trusts (referred to as a "grantor trust") of which I am an income
beneficiary and with such person or persons as my agent shall select as the trustee
or co -trustees (including my agent or any corporate trustee having at the time of
its appointment assets beneficially owned by others under its management with a
value in excess of $100,000,000), without bond or other security, and with such
other terms and provisions as my agent shall deem appropriate, including, but not
limited to, provisions.to minimize or eliminate any death or transfer taxes which
may be imposed on my estate, any grantor trust, any beneficiary of my estate or
any beneficiary of any grantor trust, and to grant to the trustee or co -trustees of
any grantor trust any one or more of the powers granted to a trustee under the
governing law of the trust; provided, however, such trust agreement shall provide
that I retain the power to revoke any such grantor trust, in whole or in part at any
time, or that I have a general power of appointment over the assets of such grantor
trust; and further provided that at my death the assets of any such grantor trust
which are treated as owned by me shall pass in a manner which is consistent with
any existing estate plan which I may have previously instituted, including
dispositions of my property by will, trust, beneficiary designation, or otherwise,
and including the apportionment of taxes and other expenses, or if there is no
person named in such grantor trust to whom such assets shall pass, then such
assets shall be delivered to the personal representative of my estate. It is not my
intention in granting the power enumerated in this paragraph to allow my agent to
change in any way the persons who will be receiving the property of my estate or
the overall scheme of my estate plan; rather, I am attempting to facilitate my
agent's ability to save taxes or otherwise reduce the costs of administering my
estate.
7
From: 08/29/2014 "-•42 #526 P.009/011
Oes No Amend, Modify, Revoke, or Terminate a Trust Created by or on Behalf of
Me. If I have already established a grantor trust, or if my agent creates a grantor
trust for me, my agent shall have the power to amend or modify such grantor trust
in a manner which is consistent with the provisions contained herein; and in
addition, any such grantor trust created by me or by my agent may berevoked by
my agent as long as such revocation results in a disposition of my estate which is
consistent with my existing estate plan. Further, my agent shall have the power to
transfer all or part of the interest I may own in any real property, stocks, bonds,
accounts with financial institutions, insurance, and other property to the trustee of
such grantor trust.
VNo Create or Change Rights of Survivorship. My agent shall have the power to
create, change, or terminate any ownership arrangement, including bank and
brokerage accounts, in which I am a joint tenant owning an interest with one or
more other persons with rights of survivorship.
e No Create or Change a Beneficiary Designation. My agent may create, designate,
or change the beneficiary of a contract procured by or on my behalf that insures or
provides an annuity payable either.to me or to another person, whether or not I am
a beneficiary under the contract, except that my agent may be named a beneficiary
of the contract or an extension, renewal, or substitute for the contract only to the
extent my agent was named as a beneficiary under a contract procured by me
before executing this power of attorney. Further, my agent may similarly designate
or change the beneficiary or benefits payable by a retirement plan, except that my
agent may be named a beneficiary only to the extent my agent was a named
beneficiary under the retirement plan before this power of attorney was executed.
Ye No Waive My Right to be a Beneficiary of Joint and Survivor Annuity,
�1 Including a Survivor Benefit Under a Retirement Plan. My agent shall have
the power to waive my right to be a beneficiary of a joint and survivor annuity,
including a survivor benefit under a retirement plan. This waiver right shall apply
to an annuity or retirement plan which is owned by me, in which I am a
participant, or in which I am a beneficiary.
Y No Disclaim Property and Powers of Appointment. My agent shall have the power
to disclaim any property, including a power of appointment, and also including
any legacy, bequest, devise, gift, or other property interest or payment due or
payable to me.
8
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08/29/2014 '1^ 13 #526 P.010/011
.ARTICLE IV
Notwithstanding any provision herein to the contrary, any authority granted to my agent
shall be limited so as to prevent this durable power of attorney from causing my agent to be taxed
on my income and from.cau'sing my assets to be subject to a general power of appointment by my
agent, as that term is defined in Section 2041 of the Code.
ARTICLE V
Any act or thing lawfully done hereunder by my said agent shall be binding on myself and
my heirs, legal and personal representatives, and assigns, provided, however, that all business
transacted hereunder for me or for my account shall be transacted in my name, and that all
endorsements and instruments executed by my said agent for the purpose of carrying out the
foregoing powers shall contain my name, followed by that of my said agent and the designation
"Agent."
ARTICLE VI
Any third party may transact any matter with my agent in the same manner and to the
same extent as the third party would transact such matter with me. Third parries who act in
reliance upon the representations of my agent shall be held harmless by me, my estate, the
beneficiaries of my estate, or joint owners of property from any loss suffered or liability incurred
as a result of actions taken prior to receipt of written notice of revocation, suspension, notice of a
petition to determine incapacity, partial or complete termination, or my death. Any third party
may rely upon a copy of this durable power of attorney certified by my agent to be a true copy of
the original hereof, as fully as if such third party had received an original of this durable power of
attorney.
ARTICLE VII
My agent shall not be liable for any acts or decisions made in good faith and in
conformity with the powers enumerated in this durable power of attorney. However, my agent
shall not be relieved from liability for breach of duty committed dishonestly, with improper
motive, or with reckless indifference to me or the purposes of this durable power of attorney.
ARTICLE VIII
My agent shall have the power to pay a reasonable fee from my estate to each agent who
is a qualified agent as defined in Section 709.2112(4), Florida Statutes as compensation for
services rendered under this durable power of attorney in an amount which does not exceed the
customary and prevailing charges for services of a similar character at the time and place such
services are performed. My agent shall also be entitled to reimbursement of expenses reasonably
incurred on my behalf.
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08/29/2014 4` 13 • #526 P.011/011
ARTICLE IX
This durable power of attorney is not terminated by subsequent incapacity of the principal
except as provided in chapter 709, Florida Statutes. This durable power of attorney shall
terminate by one or more of the following circumstances:
(1) My death;
(2) The death or deaths of all agents named in the first paragraph of this durable power of
attorney; or
(3) The occurrence of an event described in Section 709.2109, Florida Statutes.
Signed on /.�� us� 2 , 2014.
4 Cz��//`
IVA M. MCMULLIN, Principal
WITNESSES (both of whom are
18 years of age or older):
Antoinette J. DiPasqua,(Fitness
Carol R. Voller, Witness
THE STATE OF FLORIDA §
COUNTY OF ST. LUCIE §
The foregoing instrument was acknowledged before me on, 4 wz � Z,-6 2014,
by IVA M. MCMULLIN, who produced a driver's license issued by FloridA that contained
his/her photograph and signature as identification, and by Antoinette J. DiPasqua and Carol R.
Voller, witnesses.
State -of Florida
name: Vj4t-� 5, 6.0 L'_