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ANX2014-07013a � 1479 GROVE CIRCLE CT o ANX2014-07013 � � ��r� � Grove Circle Court - Multiple Properties � Zoning: Atlas #: 261 A anning & 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 COMMITTEE. 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: $0 TBD Information on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Stover, Helen Hill MAILING ADDRESS: 1452 Grove Circle Court, Ciearwater, FL 33755-2018 PHONE NUMBER: �77..,�� 30�—�'�• � �C� EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY• 1452 Grove Circle Court, Clearwater, FL 33755-2018 PARCEL NUMBER(S): 02-29-15-33750-000-0080 LEGAL DESCRIPTION: Grove Circle Subdivision Lot 8 CURRENT CITYSERVICES: REQUESTED CITY SERVICES: x (select all that apply) SANITARY SEWER SANITARY SEWER SOLID WASTE x x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562�865 Page 1 of 7 Revised 03/13 i " ° t�r � � �arwa 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 Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.25 SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) R-3, Single 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 Single Family 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 application. Sworn to and subscribed before me this _��_ day of ��cV , �O /, U . by ��/ �t�� S�Dj,�lr`� , who is personally known/has � �� produced S.�—� (Y[�'— 3�— g��i-�'6 as identification. J � � ignature of prqperfy owner or representative Signature of property owner or representative �a'otary pupnc, My commission e ' es: �, �c �rf Notary Public State of Fbrida My Commiuion EE047775 Expires 02113/2015 Planning 8 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 ° �arwater � � _ U PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation Disclosure Statement Stover, Helen Hill 1452 Grove Circle Court, Clearwater, FL 33755-2018 (727) 303-0180 OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: �J �- INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES � NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: � NO ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? � YES NO PARTIES INVOLVED-NAME: }-�;ZJ..:�,n S-j-��.�,r PHONE NUMBER: (-j27� jp� —L�c�� NAME: � PHONE NUMBER: 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 application. Sworn to and subscribed before me this �T day of '�u�'� ' au� .bY . 1/� Y/ . A �% � �CI�1 t11U S"]��,�C`— w , who is personally known/has / %- Signature of property owner or representative Signature of property owner or representative . . . - . �z�t!+e�e:t;c�vo pu =�l�y PV�^ Notsry Public State of Fbrida , �� , Scott E Jordan as identification. .i "''o�r�° Expires02/13/2015 Planning & Development Department, 100 S. Myrt 562-d567; Fax: 727-562-4865 Page 5 of 7 Revised 03/13 LL ° =: e�,r�vater � � U PROPERTY OWNER (PER DEED): Stover, Helen Hill MAILING ADDRESS: 1452 Grove Circle CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement Clearwater, FL 33755-2018 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 �mmediately or at a later time process the application to completion, including adoption and recordation of retated 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 effed. 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� Sworn to and subscribed before me this oZ� day of ��. �_. by / jl �'o �� f��„1�� S 1�v�-----who is personally known/has l� Signature of property owner (individual or authorized representative of corporation, partnership or other entity) JitY PV _�,.�: Signature of co-property owner . .. - . ��l�lit"t:� o��oF Eupires 02H 3/2015 Fbrida a -� 3- � � as identification. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562�567; Fax: 727-562-4865 Page 7 of 7 Revised 03N 3 � . __ Recording requested by:LSI When recorde�i Cetum to : Custom Recording Sotu#ions 5 peters Canyon itoad Ste. 200 Irvine, Gll 92605 � J� 7�j��,� 800-756-3524 Ext. 5011 THtS INSTRLiMENT PREPARL:D AY: Kim Henry LSI Local Solutions A Di��ision ofLSl Tide Co, �d LSI Title Agericy Tnc. 700 Cherrington Pazkw•ay Coraopolis, PA 15108 Parcel Identification tS 022915337500000080 SPACE AROVE TH[S LiNE FOK RECORDI;VG DATA QUIT-CLAIIV� DEED TNIS QUiT-CLAI,'vI DEED, made this _._f�{! 4µday of ..;_�I_L' t'��- , 2013 by Helen Hili Stover a/k/a Helen B. Stover, a single woman, whose post o�ce address is: Id52 Grove Circle Ct, Clearwater, FL 33755hereinafter called the GRANTORS, to �Ielen Hiil Stover, a single w�man, whose post office address is: 14i2 Grove Circle Ct., Clearwater, �'1, 33755, hereinafter called the GRAI�iTBE(S): VYlTNESSETH, That said Grantor, for and in consideration of the sum of Ten (S i 0.00) Doliars, and other valuable considerations, receipt whereo� is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, canveys and contirms unto the Grantee all that certain land situate in Pinel]as Cou�ty, StaYe of Florida, to-wit: Legal: Lot 8, Grove Circle subdivision, accordin� to ihe plat thereof, as recnrded in Plat Book 43, Page 29, of the �ublic Records of Yineilas County, Florids�. Assessor's Parcel No: 022915337500000080 Subject to covenants, conditions, restrictions, reservations, limitations, easements an�i agreements of record, if any, and to all applicable zoning ordinances and;`or restrictions and prohibitions imposed by governmental authorities, if any. TOGETHER WITH all the tenements, hereditame�ts and appurtenances thereto belonging or in anyw�se appertaining. 'TO HAVE AND T� HOLD, the same in f'ee simple forever. ,�ND TiiE SAID GI2r+►ItiTOR dces hereby covenants �vith said Urantee that the Grantor is lawfully seiled of said land in fee sitnple; that the Grantoz has gcwd right and lawf'ul authority to sell and cvnvey said ]and, and hereby quitciaims the title to said tand. ALL REFERENCES to the singular shall include the plural, and vice versa, and all the use of any gender shall include all genders. IN WITtVESS WHEREOF, the Grantor has signed and sealed these presents the day and year first above written. Signed, Sealed and Delivered in the Presence of Two Witnesses: .„�,,,,.-,----�< �" }.� ._,..+__,. ...-�`�.""-".,; ""'~_ ;''.,�' � .�?1�t��yai�rie�5a.ure.'Printed �e , � �' _�. � � � � � a _ i = � '�� E'�'"' � _.._._ �. � �.'*,��.�vt,ti`_..�.. ��>�`,� ....�-<- Witness SignatureiPrinied Name ; � ��,. �� ', ,��. _...._; _..._...-- ---- Witness Signature/Ptint Name , , ��., Wime >�.ztur� e%Pin eci'�ame STATE OF FLORIDA ; COliNTY OE' _�4'".�i-,��.��``y.--- } ff' t: � .� 1�,: y F� j f r JJ . �'f/,,�- �f f.l.lA.2 - � §��f, /i- �r • �'; ✓,�,. i �.k3'+-� .<.. f ./ i J..i ,f0 t.�iN'..:'S_..� { �___�._.. — ! Helen Hill Stover a/iJa Hclen B. Stover tit.. The foregoing instrument was acknowledged before me on the a� E day of ��, �� .r�}..�_ 201 �, by Helen Hill Staver atk/a Helen B. Stover who istare pe�sonallv known to me or �vho has produced =yY�;��"'.> �,,�.�`�r x�;:= as icientificaiion. �_ -- _ �_� ,----- �'��- �_ _.__.__ , . �, _ _ -_ ,. - ---°'__ —__ —,—_.......=,- . _��{..�-- t � �_�:.?V��t�-;-Si�tt�rt�zt� _.. �......� �,� i J i 3 r�' " r . a'� - ...„ : , i' p �.�.}: i i � i .L1.f y: .{ ' � ,� �, ��: -��-- . � Printed Name � rf y" My Commission Expires � y ° ' � __ } Serial Number: � u LL ° ter � � �arwa � ._� M^'� � � '? 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 COMMITTEE. 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, INCOMPIETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPL`( WITH AlL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $� IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees orAssessment Fees is available from the City of Clea►water Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Hart, Evelyn R MAILING ADDRESS: 1479 Grove Circle Court, Clearwater, FL 33755-2014 PHONE NUMBER: EMAIL: /� • � l AGENT OR REPRESENTATIVE: �� v t � � � MAILING ADDRESS: � 7 � � �` � r �' �r � ' V ' � � �` � � � PHONE NUMBER: �) � � � " �'� 7 EMAIL: � A�'f� '. �(�}^'1 P. 5 i/. .�d�M ADDRESS OF SUBJECT 1479 Grove Circle Court, Clearwater, FL 33755-2019 PROPERTY: PARCEL NUMBER(S): 02-29-15-33750-000-0130 LEGAL DESCRIPTION: Grove Circle Subdivision Lot 13 CURRENT CITY SERVICES: REQUESTED CITY SERVICES: x (select all that apply) SANITARY SEWER SANITARY SEWER SOLID WASTE x x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4567; Fax: 727-562-d865 Page 1 of 7 Revised 03/13 � � LL ° ater � � ��rw 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 APPUCATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CiTY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.234 SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) R-3, Single 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): tf residential us�, is unit(s) rental? Single Family Single Family 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 application. Sworn to and subscribed before me this c�� day of La..t a� � �i . by ��v�F'� • NGL�r--� , who is personally known/has "'L��,✓ x/� . .i�-i u'2Z - - Signature of property owner or representative Signature of property owner or representative produced �—�=�1�� Notary public, My commission expires: as identification. �ssica cu�nce MY COMMISSION # EE 868220 EXPIRES: May 30, 2016 5onded Thru Notary PubFc Underwriters �� ` 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 ti G ° rwater �� U PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation Disclosure Statement Hart, Evelyn R 1479 Grove Circle Court, Clearwater, FL 33755-2019 r 1 �o� / � G - � � � 3 � �.5 � , �r,n- �, , �c.' i� . ,;. OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBIECT PROPERTY: NAME: N � � � INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBIECT PROPERTY? PARTIES INVOLVED — NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES ✓ ` PHONE NUMBER: PHONE NUMBER: YES � l PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: .f � NO 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 application. Sworn to and subscribed before me this � day of J L5`�V� , O� � � . by � �, �� • %i�.,f'� , who is personally known/has �- ' � � i� �� ,V�n ��iv " produced _ as identification. Signature of property owner or representative ,�l , 11 - Notary public, My commission expires: Signature of property owner or representative Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL Page 5 of 7 �� EXPIRES: May 30, 201'G""` Bonded Thru Notary Public Undenrriters 0 � � �arwater Planning & Development Department Petition for Annexation � Af�davit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Hart, Evelyn R 2. That (I am/we are) the owner(s) and record title holder(s) of the ollowing described property: 1�� G�IloJ� CiI�CL� �i. C.i.�!��.i.,vA7tt2,�L ��.-��-�5— y3�5v—i�UV— U�3cJ 3. That this property constitq�tes the property for which a request for (describe request): ANN`�XQTld�J 4. That i und r igned (has/have) appointed and (does/do) appoint: 1� A �� 1 - � � t�`r' 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. That (I/we), the undersigned authority, hereby certify that the foregoing is true and correct. -T %� ,, �%� �C:-�`%�� /� �Gc� �� Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OE PINELLAS Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS �� DAY OF �L.L�� G �L-� , PERSONALLY APPEARED —� C�/-2`�� (,� ,�-�(�1— r WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. �.�:::^i%'• JESSICA WLTICE ;�� := MY COMMISSION H EE 868220 '-�� ,; EXPIRES: May 30 2016 •'f,�,o; �ry;�` Bonded Thru Notary Public Underwriters Notar � Notary Public Signature � ,�ol My Commission Expires: ��,tx.� � � Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562�567; Fax: 727-562-4865 Page 6 of 7 Revised 03/13 LL ° ter � � �ar�va � PROPERTY OWNER (PER DEED): Hart, Evelyn R Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 1479 Grove Circle Court, Clearwater, FL 33755-2019 CITY OF CLEARWATER CASE NUMBER: � � �,y,� ��. . �I � �� 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 application. Sworn to and subscribed before me this ��'� day of �� ;.�:� Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Signature of co-property owner —°��`„j ' �J `� ' bY �.�l��yr1 (�• �(�,�� , who is personally known/has � produced Notary p�blic, My commission expires: as identification. c�- L� � ��:^i%'•� JESSICACUL7ICE =ia' � : _,: .r MY COMMISSION k EE 868220 :x•, �,; EXPIRES: May 30, 2016 '•'•�p� ��,;:�� Bonded Thru Notary Public Underwtiten Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/13 KEiV flURi4c, G�.ERK rJx COURT %,ND G4i4SPTROL�ER pf:vELt_AS COUNTY. �t liVS?� 2D'�3275403 C8/22/2013 at 03:30 PM Of= REC 3K: 13733 e�G: 14t7-i44i Dx?±rpe:6E�D R�CORDiAiG: SI0.00 C p4C 5'*g.A�;P: 30.73� Pazcel ID Nvmber: 02-29-I 5-�3750-000-0130 ENHANCED LIFE ESTATE DEED THIS INDENTURE, made this 14th day of August, 2013, between EVELYty�R. HART, an unremarried wido�v, firantor, whose mailing addcess is:1479 Grove Cirele Court, Glearwater, Florida 33755, to E VELYN R HART, a single woman, as: L[FE TENANT, whose mailing address is:1479 Grove Circle Court, Ciearwater, Fiorida 33755, a life estate without arry liability for waste, wiih:full power and authority in them ro sell, convey, mortgage, lease, and otherwise dispose of the property described below in fee simple, with or without consideration, and without the joinder by the 1tEMAiNDERMAIV, to wit: DAYID lY. HART, a married man, and DAIVIEL G. HART, a married man. Uponthadeath ofthe LIFE7'EIVAIVT, tiUe shall vest in: DAVID N. HART and DANiEL C. HART, as REMA1PiDERMAN. WIT'NESSETH; That the Grantor, for and in consideration of the sum of$10.00 and other valuable considerations, receipt whereofis hereby acknowfedged, hereby grants, bargains, se(I, alierts, rcmises, releases, conveys and confirms unio the L1FE TENANT and the REAIAINDERMAN, as specifically provided hereinabove, all that certain land situate in Pinellas Couttty, Florida, viz appertaining. Lot Thirteen (13) GROVE CIRCLE SUBDISIION, according to the map or plat thereof as recorded in Plat BOOK 43, Page 29, of the Public Records ofPinellas County, Florida. Subject to convenants, restrietions and ease�nents of record. Also known as: 1479 Grove Cirde Court, Clearwater, Florida 33755 TOGETHER with all thetenements, hereditaments and appurtenances thereto belongingor inanywise Td HAVE AND �'O HOLD the same in fee simple forever. A;�ID the Grantor hereby covenants with said L8 FE TE V ANT and REMAINDERMAN that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and iawfol authoriry ta sell and convey said land;thatihe Grantor hereby fully warranu the titte to said land and wiil defend thesame against the iawful claims of all persons whomsoever. VOTE TD PROPERTY APPRAISER: T'hc Grantor ronfirms that EVEL�'N R. HART cootinues to possess not )ess than a btaeficial iaterest for lifc and continucs to be entitled fo n homestead tax exempHon, pursuant to the provisions ot Flarida Statute 146.Q4I(2). This comeyance is subject to restrictions, reservations, limitations, and easements of record, taxes for the year 2013 and subsequent years. [N WITNESS WHEREOF, the said Grantochas signed and seaied these pTesents ihe day and yeaz first above written. �tnesses: „dm.l �—t�h . :Q ,�..,i�-.�,,.+� �"G3imc55 signature ��-r+. d� J� - � rrt 6 -c��o PriMed�/� n e �"Q��A'J� � ��J � !f1 � wi� ess s�gnamre d/ �/Y! �id917�� l� v� � W � � Prirttcd name � 1�C�" �-,ti � - �7 l� EVLLY�J k. HART 1479 Greve Circle Coun Cltarwater, Florida 3�755 STATE OF FL{�RIDA t COUNTI' OF PINLLLAS ) �N THIS 14th day ofAu�ust, 2013, be1'ore me, W iltiam K. Lovelace, the undersigncd �otary, persanalty appeazed EVELYN R. HART, known to me, and who did take an oath, to be the person whose name is subscribed to the above instrument, andbeing informed af the contents ofsaid instrument, acknowledged that she voluntari{y executed the same for the uses and purposes hercin oontained. IN WI77`iESS WHEREOF, t have hereunto set my hand and ot�iciai seal. U',l�--�' _(� ��v�.��-�=-�2_ Notary Pubhc My C � !C. Lt3�1AC£ Prcparcd by & recum to: � Wil�iam K. I.ovNace. £squire - �,:. �y ��(e�$)pt�1;M��£ES45808: 401 S. Lincoln Avc. S�� Q,2t315 � Clearwaier, F133756 ' � �� •, � aqp,otN � n.b. T'his deed hac been prepued aYGrantors request without the 6enefi �..�e search. t` LL ° � ear�vater U �v a ; I,.' 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 COPIESj AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. 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 APPL►CABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $0 IMPACT FEE/ASSESSMENT FEE: TBD Informafion on lmpact Fees orAssessment Fees is availab/e from the City of Clean�vater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Hart, Evelyn R MAILING ADDRESS: 1479 Grove Circ�e Court, Clearwater, FL 33755-2018 PHONE NUMBER: n/a EMAIL: n/a AGENT OR REPRESENTATfVE: David N. Hart MAILING ADDRESS: 1479 Grove Circle Ct. Clearwater FL 33755-2018 PHONE NUMBER: 727-480-4597 EMAIL: dhart2@tampabay.rr.com ADDRESS OF SUBJECT 1473 Grove Circle Court, Clearwater, FL 33755-2018 PROPERTY: PARCEL NUMBER(Sj: oz-z9-is-3a�sa000-oizo LEGAL DESCRIPTION: Grove Circle Subdivision lot 12 CURRENT CITYSERV/CES: REQUESTFD CITYSERVICES: X (select all that apply) SANITARY SEWER SANITARY SEWER SOLID WASTE x x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: T27-562-4567; Fa�c: T27-562-4865 Page 1 of 7 Revised 03/13 t � O � � ear�vater � 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 WILI RESULT IN YOUR APPLIfATION BEING FOUND INCOMPLETE AND P�SSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LANO USE PLAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU} REQUESTED (CITY): Residential Urban {RU) ZONING DISTRICT PRESENT (COUNTY): R-3, Single Family Residential REQUESTED (CI1Y): Low Medium Density Residential (LMDR) SITE AREA: 0.235 acres SIZE OF DEVELOPMENT : Existing: 0 Proposed: 0 (e.g., number of un+ts, hotel rooms or non- residentialsquare footageJ USE OF PROPERTY: Existing {currently on site): Proposed (new use, if any; plus existing if to remain): tf residential use, is unit{s) re nta I? Vacant Vacant m STATE OF FLORIDA, COUNTY DF PINELLAS I(we), the undersigned, acknowledge that all representations made in th9s application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the properry described in this application. Sworn to and subscribed before me this c�� day of J l.�`�-� .� C� � . by ��-��-j � (�� i+GLf�" . who is personally known/has y �' ��'� �i � Signature of property owner or representative Signature of property owner or representative produced � Nota�, My commissiun expires: as identification. 2�� JESSICA CULTICE MY COMMISSION p EE 868220 EXPIRES: May 30, 2016 Bonded Thru Notary Puhlic Undenvriters Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03113 c ' LL ° � earwater rJ PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAI L: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAI L: Planning & Development Department Petition for Annexation Disclosure Statement Hart, Evelyn R 1479 Grove Circle Court, Clearwater, FL 33755 n/a n/a David N. Hart 1479 Grove Circle Ct. Clearwater FL 33755 727-480-4597 dhart2@tampabay. rr.com OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: None INTEREST IS: n/a SPECIFIC INTEREST HELD: n/a DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT !S: PARTIES INVOLVED — NAME: NAM E: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVFD — NAME: NAME: ARE THEREANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: X NO X NO X 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 application. Sworn to and subscribed before me this �� day of J �a`..� . �� . by � ��\�.;v� '�-• ��GL.+r"� , who is personally known/has <�/Lc� '-�� i'� (?�C�� produced _ as identification. Signature o# property owner or representative Notary public, My commission expires: Signature of property owner or representative Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 3�,�1�27=5�'N Page 5 of 7 ��'��',�a eor�ded rnN Not�, �� 3 LL ° � earwater Planning & Development Department Petitian for Annexat�on � Affidavit to Autharize Agent f Representative 1. Provide names of all property owners on deed — PRINT ful) names: Hart, Evelyn R 2. That {I am/we are) the owner�s) and record title hotder{s) o#the following described property: 1473 Grove Circle Court, Ciearwater, FL 33755 02-29-15-33750-000-0120 3. That this property constitutes the properly for which a request for (describe request): Annexation into city in conjunction with sanitary sewer project 4. That the undersigned (has/have) appointed and (does/do) appoint: David N. Hart 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. That (I/we), the undersigned authority, hereby certify that the foregoing is true and correct. <�'-�(,i� e�<%�,✓ � r{�"Lf�`� Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONEC7 BY THE LAWS OFTHE STATE OF FLORIDA, ON THIS � DAY OF �� L-� d O(� PERSONALLY APPEARED C�2 `� �`-1 �- C��-� WH� HAVIN6 BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE C�NTENTS OF THE AFFIDAVITTHAT HE/SHE SIGNED. " �" JESSICA CUITICE �4�1:. °U� � ±� += MY C0�IMISSION N EE 8od220 � ��a^ EXPIkES: May 30 2016 '�;p,'� � 4�:`�� 8onded Thru Notary Public Underwriters Notary Seal/Stamp Notary Public Signature � � � My Commission Expires: �v�,(�� "�j4 U� Planning 8� Development Department, 100 5. Myrtle Avenue, Clearv,rater, FL 33756, Tel: T27-562-4567; Fax: 727-562-4865 Page 6 of T Revised 03/13 J ° �arwater �� u Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED}: Hart, Evelyn R MAILING ADDRESS: 1474 6rove Circle Court, Clearwater, FL 33755 CITY OF CLEARWATER CASE NUMBER: I/we, Evelyn R. Hart [insert names of all property ownersj, 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 comptetion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in anyAgreement to Annex executed by meJus 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 application. Sworn to and subscribed before me this �� day of � � �..� , a� �a . by ��u1.-� IL• C�-� T. who is personally known/has � �'. ,, (,' 1-�/I.:� ��LA--�' � � ` f produced as identification. Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Signature of co-property owner Notary public, My commissian expires: �� 3� , C�I.J `� JESSICA CULTICE b1`( COMMISSION N EE 868220 EXPIHES: May 30, 2016 yunded Thru Notary PuDUt Underwriters Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/13 �, ' Y�IV 8URKE. Ct£RK OF COU??T AiYD CQ,�1?T?�p�i�R pIVELl,qS COUit,-; Y. FL 1NS7# 2�'3T7�;�.,J,gn2�Zfl�3 at 03:3.4 P14� Or� REC 3K: ?9133 PG• ia7S-xe7o CocTy�e: pEED REGOf20tNG: 31Q.{+C � orx s,—�r�o: so.�e Pazcel ID Number: 02-29-i5-33750-000-0120 ENHANCED LIFE ESTATE DEED THLS IIVDENTURE, made this 1 dth day ofAugust, 2013, 6etween.EV�LYN iL �iART, an unremarzied widaw; Gra►rtor, whose mailing address is: 1479 Grove Circle Court, Ciearwater, Florida 33755, to EVELYN R HART, asinglewoman, asLIFETENANT,whosemaiiingaddressis:1479GroveCircleCowt,Clearwater,Florida33'755, a life eszate without anyliability for wasie, with fu11 power and auttwriry in them ta sell, convey, mortgage,.lease, and otherwise dispose of thc property described below in fee simple, with or without consideration,:and without the joinder by Che RE1NAtNDERMAN, to wit: DAYID 1V: HART, a married man, and DAIVIEL C. HART, a marTied man. Upon the death of the LTFE TENANT, title shall vest in: DAYID N. HAR? and DAN[EL C. HART, as REMAINDEr'2MAN. WITNESSETH: 3'hat the Grantor; for and in consideration of the sum of $10,00 and other valuable considerations, receipt whereof is hereby acknowledged, hereby granis, bazgains, sell, aliens, temises, rcleases, conveys and confirms unto the LiFE TENANT and the REMAiIVDERMAN, as specifically provided hereinabove, a11 that certain land situate in Pineilas County, Florida, viz: Lot Twelve (12) GROVE CIRCLE SUBDISIION, according to the map or piat thereofas recorded in P1at BOOK 43, Page 29,ofthePublicRecordsofPinellasCou�ty,Florida. Subject to canvenants, restric#ions and easements of record. Also known as: � Grove Circic Coun, Clcarnater, Florida 33755 TOGETHERwithall the tenements, hereditaments and appurtenances thereto belonging or in anyw�ise appertaining. TO HAVE AtVD TO HOLD the same ia fee simple forever. AND ttte Grantor hereby covenants with said i;i F'E T�;NAh'T and REMAINDERMAN that the Grantor is lacvfully seized of said land in fee simpie; that the Grantor has goud right and lawful authority to sel l and cunvey said land; that the Grantor hereby fulty warrants thetitle to said land and will defend the same against the lawful claims of all persons whomsoever. This conveyance is subject to restrictions, reservations, limitations, and easements of record, ta.Yes for the vear 2413 and subsequent yeazs. ' IN WITNESS WHEREOF, the said Grantor has si�ned and sealed these presents the day and yeaz first above written. tnesse`�jc� i ��.� � dness signaiure �t++.�— /�t ,�6ibS+Nd Prinied �� "�� n°ess signatu � 1��-�- f !!��,/��:� Printed name �„�;r--c;��,,,,_. ,;2 , �}��" EVELYN:�. HART 1499 Grov� Circle Court Ciearwacer, Florida 33755 STATE OF FL03tIDA ) COUN7'Y OF P[NELLAS ) ON THIS 14th day ofAugust,2013, before me, William K. Lovelace, the undersigned notary, porsonally appeared EVELI'AI R. HART, known to me, and who did take �o aath, to he the persan whose ra e is �u�scri5e�! *.� tt�e above instrument, snd being infornied of�lic coments ufsaid instrument, acknowledged thatshe voluntarity executed the same for the uses and purposes herein contained. IN WiTNESS WHF,itEOF, l have hereunto set my hand and o�cial seal,.� Prcpnred by�$� rctum to: Wiiliam K. LovGlace, Esquae 40! S. Lincoln Are. Cicaiwater, }L 33756 ?Ny n b. "I his deed has betn prepared at Grantor'z rcquest without the �S�S�KsSt��oq�,�F 9C. Lt?v�v+*�� . ;'!; MY COMMiSSK?� � EEtA3� �� EXPtRE5l�bvert`b� ��0�5 . wi53 - [ide $earch.