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ANX2014-08014•, . LL ° � �arwate � �_ U 1250 PALM ST ANX2014-08014 1 Cassidy, Bill J & Dorothy Zoning: & Development Department Atlas#: 251B ;ion for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR DELIVERIES) TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. A TOTAL OF 14 COMPLETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS (1 ORIGINAL AND 13 COPIES) AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. APPLICATIONS AND SUPPLEMENTAI MATERIALS ARE REQUtRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: IMPACT FEE/ASSESSMENT FEE: $0 TBD Information on Impact Fees orAssessment Fees is available from the Cify of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Bill J. Cassidy and Dorothy Cassidy MAILING ADDRESS: 102 Farrar Drive, Aurora, IN 47001-1618 PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 1250 Palm Street, Clearwater, FL 33755 PROPERTY: PARCEL NUMBER(S): 03-29-15-15840-001-0260 LEGAL DESCRIPTION: Cleardun, Block A, Lot 26 CURRENT GTYSERVICES: SANITARY SEWER REQUESTEDCITYSERVICES: � SANITARYSEWER (select all that apply) SOLID WASTE � SOLID WASTE � WATER Planning � Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 LL ° earwater �� U Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU) REQUESTED (CITY): Residential Urban (RU) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.141 SIZE OF DEVELOPMENT : Existing: 1 Unit Proposed: 1 Unit (e.g., number of units, hote/ rooms or non- residential square footage) R-4, One, Two, and Three Family Residential Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site); Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s) rental? Single Family Home Single Family Home .�.N.�.JIh1,itA �t'A+C.P.siw.2� STATE OF�, COUNTY OF RIOLELIAS �(we), the undersigned, acknowledge that all reoresentations made in this aqplication are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this I S day of �v � i 'Zo � �.} . by -/ � �� . �� , �� - � 2a�4�6�i1 ��'��i , who is personally known/has i produced ��+Z�- .�-. V as identification. Signature of r y wner or represen tive ,� ,, ,. / �,� , Notary public, My commission expires: /'�✓�/�o Signature of pro�erty owner or re�esentative �;»;.�,�� My Comm. F�pbeB 07-15�2016 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/13 LL ° : rw ter ��ea a U Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR ANNEXATION PACKA6ES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ❑ Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. [Note: Submit two copies only] ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plai, and engineeri7g plans. . ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. If the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). [Note: Submit two copies only] ❑ If connedion to city services is desired prior to the efFedive date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). [Note: Submit original only] ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). [Note: Submit original only] INFORMATION REQUIRED TO COMPLETE THE PETITION FOR ANNEXATION APPLICATION AND DATA SHEET CAN BE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ PARCEL NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.or� (search database by address). ❑ LE6AL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.or�. ❑ FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascountv.or�/public �is/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http:/1�is.pinellascountv.or�/public �is/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at http://www. myclearwater.com/QOV/depts/pwa/en�in/pu blications/engatlas/atlas.asp. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascountv.or�/qublic �is/. Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 Revised 03/13 LL ° ater � � �earw U ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Anplicants The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determir�ing whether to annex a proFerty, the City shall co�sider t�i extent to which: ❑ The prop�sed annexation will impad public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall compty with all applicable City of Clearwater regulations and ordinances as set forth in the City Code of Ordinances; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the ciiy's Community� �eve!�pment Cod� ;s�e �4hr:�:6ttal Paekage Instructions Ctiecklist). �t �s rec3mmencleu� tha*. the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning 8� Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 03/13 LL ° � �arwater � U PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHCNE NUMBER: EMAII: Planning & Development Department Petition for Annexation Disclosure Statement Bill J. Cassidy and Dorothy Cassidy OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: � INTEREST IS: ) ` —r �. �. SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED - NAME: NAM E: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED- NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED - NAME: NAME: _ YES �( NO �� PHONE NUMBER: PHONE NUMBER: _ YES � NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: � NO �I-N�i /tA�`�}' �G�,� � STATE OF ftA�R�9A,.COUNTY OF-P11��43' 4� (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my � knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this �� day of J" � —, ZC I�t . by � %� � � • � � -� �0 26 i-k . , C, � y �+'� �`-��C��I , who is personally known/has �� producec� �i��E �J as identification. ature Signature of roperty owner or repr sentative � �'��.�a�t_�1 ro rty owner or repr ntative Notary public, ' My commission expires: �- �� -�� o�iciu s�x I�ICartrn Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562�567; Fax: 727-562�865 Page 5 of 7 Revised 03113 LL ° - rwater ��a Planning & Development Department Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Bill J. Cassidy Dorothy Cassidy 2. That (1�ii/we are the owner(s) and record title holder(s) of the following described property: 12.y�C? �� 1_��3�� .G� , C;�.��.�,��; ��_ 3. That this property constitutes the property for which request for (describe request): =��% -tj-i-� r � � � � _ 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. � e��ndersigned �r A . Property Property Own ority, hereby certify that the foregoing is true and correct. perty Owner Property STAT� OF�; COUNTY OF � .J.�I 1� � H-Ai r'� ✓a-�(iC �=Ai „1N0: R N,9 BEFORE ME THE UNDERSI6NED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE Of�, ON THIS �� DAY OF ��,,,Y Z� I�.j- , PERSONALLY APPEARED � � L I -�- 1,1-� /1�-F (�,�a C�SSj(f � WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE •,.rs OFFICNLBEAL d DAVID J. WUNDERLICH � NOTARY PUBLIC - INDIANA DEARBORN I�UNT1r w� � e,e � My ()prt1111. E�hBS 07•15-2016 Notary Seal/Stamp NTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. otary Public Signature My Commission Expires: � /,��/('p Planning 8� Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 03/13 • . . , . LL ° rwater ��ea Planning & Development Department Petition for Annexation � Supplemental Statement PROPERTY OWNER (PER DEED): Bill J. Cassidy and Dorothy Cassidy MAILING ADDRESS: 102 Farrar Drive, Aurora, IN 47001-1618 CITY OF CLEARWATER CASE NUMBER: �We � / - �z �U�'a!/ [insert names of all property o ne ], having filed a etition for Annexation regardin � the above property/cas number, grant consent, agree and acknowledge that the City o Clearwater may immediately at a later time proces the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by r�/us orc�r/o�r predecessors in interest. �we further agree and acknowledge that �we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. � ._J-r�i��`�1;,9 �,��f3o�1) STATE OFf�BA, COUNTY OF�4S �+(�, the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this 1S day of �l� Zo� . by 1 � � i I ��- �Ja2o�-�ty �1�-55 iC�( , who is personally known/has � n � (,, �� /�� ,t�� .� �� produced �IC�v,�E; Tt� as identification. Signature �f representati entity) r�-� Signature of bperty owner (individua�r authorized of corporation, partner ip or other owner Notary public, My commission expires: � /� o�cw. �u My Comm. FaQ�Y�96 07-15•2016 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: T27-562-4865 Page 7 of 7 Revised 03/13 . � 1 . 7uly 9, 2014 �it� of �lear�va��r Cleanvater Planninb & DeveloE�ment, Post Office Bos 4748, Clearwater, Florida 3375g-474`� 100 South IV�yrtle Avenue, Cleariv�iter, Florida 33756 ,. Telephane (727) 562-4567 F�uc (727) 562-4865 Bill and Dorothy Cassidy 102 Farrar Drive Aurora, IN 47001-1618 Dear Mr. and Mrs. Cassidy, The City of Clearwater received your Form of Commitment and check #10445 in the amount of $900.00 for connection to the City sewer service at 1250 Palm Street. Since your property is contiguous to property within the City limits, you may annex into the City now. You will need to complete the Petition for Annexation form, which is enclosed with this letter. I have filled in some of the information for you. Your check will be processed when we receive this completed application. The annexation process will take approximately three months to process from the time we receive your completed application. If you would like to receive trash service at this property prior to that time, please complete page 7, Supplemental Statement, of the application. �.This statement assures the City that you will not rescind your Petition of Annexation. _�. Please call me at 727-562-4557 if you have any questions regazding the application. I would be happy to assist you. Sincerely, / , Katie See, Planner III Gcurgc N. Cretekos,l�I<tyor Bill Junson, Cuimcilmember J:ry Polglaze, Ce�uncilmen�her IIoy�t IIamilton, Cc�uncilmcmber porccn II<xk-DiPolitu, Councilmcmbcr "Equal Employincnt an�l rlffirmative Actiun Emplc�ycr" . LL ° � earwater U Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR DELIVERIES) TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. A TOTAL OF 14 COMPLETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS (1 ORIGINAL AND 13 COPIES) AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMI7TEE. APPLICATIONS AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLiCATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: IMPACT FEE/ASSESSMENT FEE: PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: $0 TBD Information on Impacf Fees orAssessment Fees is available from ADDRESS OF SUBJECT PROPERTY: 1325 Idlewild Drive PARCEL NUMBER(S): 03-29-15-12060-012-0110 LEGAL DESCRIPTION: Brooklawn Block �, �ot 11 CURRENT CITY SERVICES: REQUESTED CITY SERVICES: (select all that apply) SANITARY SEWER �J SANITARY SEWER SOLID WASTE ✓SOLID WASTE V WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 ° arwat�r �� U Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATtON PRESENT (COUNTY): Residentiai Urban (RU) REQUESTED (CITY): Residential Urban (RU) SITE AREA: ZONING DISTRICT PRESENT (COUNTY): RE4UESTED (CITY): 115 SI2E OF DEVELOPMENT : Existing: Proposed: (e.g., number of units, hotel rooms or non- residential square footage) One, Two and Three Family Residential (R-4) Medium Density Residential (MDR) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s} ici�iai:� STATE OF FLORIDA, COUNTY OF PINELLAS I(we), ;he andersigned, acknowledge that all representations made in this appli�ation are true and accurate ±o the best of my knowledge and authorize City representatives to visit and photograph the property described in this applicatio,n Swo n to a,�d subscribed before me this _ � day of � " ao � . bY l�i��I.� �� n �- � � 1 17 � /7 6/L�y w is�p��'sonally known/has ��+, _ produced �L L� U-� �� GiI'S � iaentification. S� a u / S ;�x; � t roper owner or repres -�io -� - ��7` i �� of prope y owner or repres �t � `��', � �/�a �� ve G �/ ��/ �� No�ay public, My commission expires: 2��Y "��4^ Notary Public , Jane Sloan �.� � ,� ; My CommiesH Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, TeI: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/13 0 ot Florid EE082292 0 LL ° r�vater � � �a U PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: �" ll � Planning & Development Department Petition for Annexation Disclosure Statement _- . .� � ,� �+r:, Vl �.� G,�GJ Ul�, �� Gc�wi OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: �1 � SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF CONTRACT IS: PARTIES INVOLVED — NAME: NAME: B1ECT PROPERTY? ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED— NAME: - N��AF• r , ,......�. 4: i�,� ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: . NAME: '� YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PH(1NF NI IMRFR• YES PHONE NUMBER: PHONE NUMBER: � NO NO STATE OF FLORIDA, COUNTY OF PINELLAS I(we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this app�c�ti¢r� - Swo to an subscribed before me this ��J day of � 1�!, � - �� L �-�/' �,��,�N/�� Y /`I �1 � `� � %�l � 7 �b w �`� �rsonally known/has '/D�... . �✓r. l � produced Y� �U� � �i �/L�s identification. �'Si at r of o e own or re�ese ative �. - , -�i � � ��/ - o � X i �� i a/��o�i,- Not�f�y public, / / My commission expires: �. ��j � �✓ �ignat 2 OT Ciy OW er or rep�sent iIV � / � ` + ' � ° ' " „'� "� '�` v �'+� � j✓' � �,� a� p'�9� Notary Public State of Fiorida ✓ J % / ;� � ,� �, =w,� : a My Commission EE082292 �� /� 1P19 g& Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727 �82-�6fi7; Eaparea2Al56�a�865 Page of 7 _. ,�r-vn.r�, �� LL ° � earwater � PROPERTY OWNER (PER DEED): MAILING ADDRESS: Planning & Development Department Petition for Annexation Supplemental Statement CITY OF CLEARWATER CASE NUMBER: � � �.�_ - I/we, _ [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. STATE OF FLORIDA, COUNTY OF PINELLAS I(we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this applicatio Swo to an�l subscribed before me this ' day of /-� %�� , ir . � -�n � , � --�- - , „ �.� � � �� U ��bY lJ``%��"�%�i� �� I � i- fi � i personally known/has ,(.� c /,�/�—_ _� produced � �G' L- l� l C�/ v�� s identification. representative of entity) _, Signature of X t�� k ner (individual or authorized p�rtnership ��,� � owner �� 1�1��d other,J � f� -��- y /��/ �gYary public, ` My commission expires: �, ;:�, o My Commissan EE082292 ��o� F�oo- Expires 04l10/?916 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/13 Parce1 Tax I.D. No.(s): 03/29/15/12060/012/0110 This InsWment Prepared by and Refum to: Douglas L. Hilkert, Esq. DouG�AS L. Hi��RT PA. 2557 Nursery Road Suite A Clearvvater, Florida 33764 (72� 507-9559 FILE NUMBER: 233&8058 SalelTrensfer Price: S 55,000.00 Amount of DocumeMary Shamp Tax: $ 385.00 THIS DEED IS EXECUTED IN COUNTER-PARTS WITH THE DOCUMENTARY STAMPS BEING AFFIXED TO THE FIRST DEED RECORDED. ��tt� ��P� lstamcoN Fom,) (Wherever used hceiq tho term "Granror" and "Grantee" shall mclude the heirs, persooal representativa, successors and/or assigns of the rapective partia heroto; the use of tfie singular number shall includsthe plural, and the plural the singular; the use of arry gender shall include al I genders.) TffiS INDENTURE, made this FEBRUARY 13, 2013 BETWEEN DONNA L. DOwELL, ("Grantor") of McHenry County, State of tllinois, and TrIIEN J. HARRAH AND dOHN PERGAMO, ("Grantee"), whose tax mailing address is 2600 Paula Drive North; Dunedin, Florida 34698. WITNESSETH, that Grantor, for and in consideration of the sum of Ten Dollazs ($10.00) and other good and valuable consideration, to Grantor in hand paid by Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to Grantee, Grantee's heirs and assigns forever, the following described land, situate, lying and being in the County of Pinellas, State of Florida, to-wit: Lot 11, Block L, BROOKLAWN, according to the map or plat thereof in Plat Book 13, Page(s) 59, Public Records of Pinellas Counry, Florida GRANI'OR HEREBY CERT7FIES that the subject property is not homestead property nor is it contiguous thereto. Subject to easements, resh-ictions, and reservations of record, and taxes for the year 2013 and thereafter. And Grantor does hereby fully wanant the title to said land, and will defend the same against the i�i.,�,t �ta;.,,� �faii pers��s :•,tie�.s�e:�cr. IN WITNESS WHEREOF, Grantor has hereunto set Grantor's hand and seal the day and yeaz first above written. Signed, sealed and delivered in our presence: Sign_ �`-""� ' ` �� . ��'` � �. _� � (� Q�[ / � 10NNA L. DOWELL � 34 Illinois Street ;rystal Lake, IIlinois 60014 STATE OF ILLINOIS < <^ COUNTY OF MCHENRY �' �� y;,�_, The foregoing instrument was ackno��wiedged before me this � day of Febniary, 2013, by DONNn L. DOVVELL, who is personally known to me (or who has produced �'� i v�"N'S `C ��-t— as iden[ification). �� "OFFICI ^.L SEAL" KiRAN RATHi Notary Public. State oi Illinois My Commission Expires June 27, 2015 :r.C�"�%'t .'�� NOTARY PUBL]C: Sign--�� n--- ll�-�-LIJV''�` Print � i �f��(�i% J'� l�l "T�'�� My CommiTion Expires: r1 C`/��. 2%��-�`7 i J� �/