AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA ORAN C um'y GOVERNMENT 1' I. 0 11 1 I/WE, (PRINT PROPERTY OWNER NAME) Bill or Meredith Rollis, AS THE OWNER(S) OF THE REAL PROPERTY DESCRIBED AS FOLLOWS, 6208 Crescent Moon Court, Windermere, DO HEREBY AUTHORIZE TO ACT AS MY/OUR AGENT (PRINT AGENT'S NAME), Sheila Cichra, TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE APPLICATION APPROVAL REQUESTED AND MORE SPECIFICALLY DESCRIBED AS FOLLOWS, Boat Dock Permit, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS APPLICATION AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING ;0 THE PL TIO Date: Date: Date: Date: STATE OF FLORIDA COUNTY OF ORANGE Signature Property Owner Signature of Property Owner Signature of Property Owner Signature of Property Owner (LA )1404,4 Print Name Property Miner Print Name Property Owner Print Name Property Owner Print Name Property Owner I ertify that on State of Florida and CsICt (,-ek e, r_s instrument _73//0 /7, before me, 61,/,-) /7914-1-1, an officer duly authorized by the in the county mentioned above, to take acknowledgements, personally appeared, to me known to be the person described in this instrument_or to have produced as evidence, and who has acknowledged before me tha he -br she executed the not take an oath. Cti\ Witness my hand and official seal in the county and, state stated above on the in the year 2016. WYNN ALLEN Notary Public State of Florida ( N FF 923070,,,. My Comm. Expires Sep 30.2019 ;,, Bonded through Nstamai Notary Assn. 41( attu,-- Signature of Notary Public Notary Public for the State of Florida My Commission Expires: day of Legal Description(s) or Parcel Identification Number(s) are required: PARCEL ID #: 22-23-27-1527-00-460 LEGAL DESCRIPTION: Lot 46, Eden Isle, as per Plat Book 52, page 9
DOC# 20150652647B: 11029 P: 3929 12/17/201511:26:24AM Page 1 of Rec 2 Fee: 18.50 Thisdocumentwaspreparedby D and shouldbe returnedto: da n ne : 070 IntangibleTax: $0.00 WARREN T,CHANNELL, ESQUIRE Mortgage stamp: $0.00 160 SouthMain Street 11artha0. Haynie, Comptroller Orange County, FL WinterGarden,Florida34787 MB - Ret To: WARREN T CHANNELL ESQ ParcelIdentification Number:22-23-27-1527-00460 QUIT-CLAIM DEED THIS QUIT-CLAIM DEED, Executed this16th day of December 2015 by first party, Grantor, ROLLIS CONSTRUCTION AND RENOVATION, INC. a Florida Corporation, whose address is 164 South Main Street, Winter Garden, Florida,34787 to WILLIAM ROLLIS and MEREDITH ROLLIS, husband and wife, whose address is 6208 Crescent Moon Court, Windermere, Florida,34786, hereinaftercalledgrantees. WITNESSETH, That the said first party, for good considerationand for the sum of ten dollars ($10) paid by the said second party, the receipt whereof is hereby acknowledged, does hereby remise, remit and quitclaim unto the second party forever, allthe right, titleand interest which the said first party has in and to the following described parcel of land,and improvements and appurtenances theretoin the County of Orange, Stateof Floridato wit: Lot 46, of EDEN ISLE, According to the Plat Thereof, as recorded in PlatBook 52, at pages 9 through 18,Inclusive,of the Public Records of Orange County, Florida. TO HAVE AND TO HOLD the same together with alland singular the appurtenances thereunto belonging or in anywise appertaining, and allthe estate,right țitle,interest,lien equity and claim whatsoever of the saidfirst party, eitherin law or equity, to the only proper use, benefit and behoove of the second party forever. Page 1 of 2
IN WITNESS THEREOF, The saidfirst party has signed and sealedthese presents the day and year firstabove written. Printname Signed, ed anddeliv inthepresenceof: itness signature Printname PrintName STATE OF FLORIDA COUNTY OF ORANGE IHEREBY CERTIFY thaton thisdaybeforeme appeared WILLIAM ROLLIS, aschairmanandon behalf ofrollisconstruction and Renovation,Inc.,personally known tome (orprovedtome on thebasisofsatisfactory evidence)tobe the person whose name issubscribedtothewithininstrumentand acknowledged tome thathe executedthesame inhisauthorized capacity, and by his signature on theinstrument, the person who executedthe mstrument. WITNESS my handandofficial seal. ohry PUBLIC KRISTINACATHLEEN ZENZ n MY COMMISSION#FF153829 \ / EXPIRESAugust 24,2018 r PA (407) 3 0153 FloridaNotaryService.com PRINTED NOTARY NAME Page 2 of 2