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ANX2014-100211712 Grove DR ANX2014-10021 LL 1 0 > �� 1712 Grove Drive ' Zoning: Low Medium Density Re Atlas #: 264q � �..i-�.� .., � 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 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: $0 IMPACT FEE/ASSESSMENT FEE: TBD lnformation on lmpact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Kathryn Lohmeyer and Mike C. lohmeyer MAILING ADDRESS: 1010 Park Court, Suite C& D, Safety Harbor, FL 34695 PHONE NUMBER: 727-385-6297 (Mike); 727-580-2660 (Kathryn) EMAIL: mlohmever@tampabav.rr.com; k.lohmever@championrb.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 1712 Grove Drive, Clearwater, FL 33759 PROPERTY: PARCEL NUMBER(S): LEGAL DESCRIPTION CURRENT CITYSERVICES: 05-29-16-94338-004-0040 Virginia Grove Terrace 15t Add Blk 4, Lot 4 SANITARY SEWER REQUESTEDCITYSERVICES: x SANITARYSEWER (select all that applyJ SOLID WASTE x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 o ^� Planning & Development Department � C earwatr 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 SITE AREA: PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): RE4UESTED (CITY): 0.19 SIZE OF DEVELOPMENT : Existing: Proposed: 0 Units 1 Unit (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? Vacant Lot New Single Family Dwelling ni� 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 � ��. by /��Jf� who is personally known/has /- � � ^ produced as identification. ignatur of prop r y owner or representative ,.,,��,,, _ _ ,,, � iii,(� ; ��",��; •s IAVAN DEMETRIUS PETTAWAY 6�otary publi� // ��, �; My Comm. Expins fep 20, 201e �� ,; a<«�;:� Commission #� ff 09�709 My commission expires: �,,,,,,• � . of property owner or� resentative 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 ° earwater �C � Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Kathryn Lohmeyer and Mike C. Lohmeyer MAILING ADDRESS: 1010 Park Court, Suite C& D, Safety Harbor, FL 34695 PHONE NUMBER: 727-385-6297 (Mike); 727-580-2660 (Kathryn) EMAIL: mlohmever@tampabay.rr.com; k.lohmever@championrb.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT I5: PARTIES INVOLVED - NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED - NAME: IVAMt: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED - NAME: NAME: YES j�C NO PHONE NUMBER: PHONE NUMBER: YES ��( NO PHONE NUMBER: 1'I-IUIVt IVl.11VItStt(: YES PHONE NUMBER: PHONE NUMBER: � 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 applicati n. � Sworn and subscribed before me this � day of L�• bY � � l? i� who is personally known/has � produced : as identification. --- -_ _—__ -- - --- � Sign owner or representa z--� Sign�fure of property owner or�esentative Notary public, My commissio res: .,:. N911ty Publ�c • Stote ot F�orida M� Qomm. Expfn: Feb 20, zote Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 03l13 LL ° � earwater Planning & Development Department Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Kathryn Lohmeyer Mike C. Lohmeyer 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 1712 Grove Drive, Clearwater, FL 33759 3. That this property constitutes the property for which a request for (describe request): Annexation of 1 residential lot into the City of Clearwater 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(sj 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�ive), the undersigned aut�hority, hereby certify that the foregoing is true and correct. erty Property STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS . ,3a DAY OF ��1./i/ ' �7 PERSONALLY APPEARED DEPOSED AND1.fAYS THAT H Notary Seal/Stamp WHO HAVING BEEN FIRST DULY SWORN ULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. ; i:�""�a� LAYAN DEMETRIUS PETTAWAY ,� _ . . , = Not��y Puplic • Sqte o1 Florida otary Publi ,�"' •c Y omm. z , 2018 . „� .. . Commission A� Ff 094I09 My Commission Expires: 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 o � Planning & Development Department � C ear�vate Petition for Annexation " Supplemental Statement PROPERTY OWNER (PER DEED): Kathryn Lohmeyer and Mike C. Lohmeyer MAILING ADDRESS: 1010 Park Court, Suite C& D, CITY OF CLEARWATER CASE NUMBER: Harbor, FL 34695 I/we, [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowiedge 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?.�� Swor/to and subscribed before me this �v day of ,' �/y bY � i who is personally known/has �� ,.�� produced � as identification. SignaCure of prop�rty owner (individual or a Y�orize representative of corporation, partnership r other entity) otar pub i My commiss Signa re of co-pro er y owner ires: LAVAN DEMETRtUS PETTAWAY My Comm. Expires Feb 20, 2018 Commission �Y Ff 094709 Planning 8. Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03113 Prepared By and Return to: Michele Wiiliams Fidelity National Titfe of Florida, Inc. 28059 US Highway 19 North, Ste. 100 Ciearwater, FL 33761 Fite No. FT05-13000978 Property Appraiser's Parcel I.D. (folio) Number(s) 0 5/29/ 16/94338/004/0040 consideration �35,000.00 WARRANTY DEED THIS WARRANTY DEED dated February 15, 2013, by Virginia F. Allen, a single woman hereinafter called the grantor, to Mike C. Lohmeyer and Kathryn A. Lohmeyer, husband and wife whose post effice address is 2618 W Grand Reserve Circle #639, Clearwater, Fl. 33759, hereinafter called lhe grantee: (Wherever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) WITNESSETH: That the grantor, for and in consideration of the sum of $10.00 and other vafuable consideration, receipt whereof is hereby acknowiedged, hereby grants, bargains, sells, aliens, remises, releases, conveys, and confirms unto the grantee, all the certain land situated in Pinellas County, Florida, to wit: Lot 4, Bfock 4, Virginia Grove Terrace First Addition, according to the map or plat thereof, as recorded in Plat Book 37, Page(s) 62, of the Public Records of Pinellas County, Florida. JUL)BCl lV CctJClllCrllJ, ICJIIiI.liViiJ� ICJCIVQL'IUIIJ OIlU ii�itilciliViij Vi (GI�V(u� ii Giiy. TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in any wise appertaining. TO HAVE AND TO HOLD the same in Fee Simple forever. AND the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good righf and lawfu! authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsaever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2Q12. Warranty Deed (Individuai to Individual) Rev (3l00) IN WITNESS WHEREOF, the said grantor has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in the presence of: . , � — Vir ia F. Atlert Address: 204 Sunnypoint Avenue Oak Hill, WV 25901 State of .YV � County of e� � The foregoi— -�ume_nt/was acknowledged bef�or/� me this � day of 2��,�.a-r��j ��, by �(�Ytl�+l � � . ��N � to m�% described in or who has/have produced as identification and who e instrument and he/she/they ackno�Nledged that he/she/they executed the same. V`yj2ciess my hand and o�cial seal�in the County and State last aforesaid this �ay of y�,�pr t�c�.a�q , GV_�. Warranty Deed (individuai ko Individual) Rev (3/00) OFFICIAL SEAL NOTARY PUBLIC STATE OF WEST VIRGINIA KIMBERLY K. PARMER PARMER IAW OFFICE 104 JAMES STREEi HINTON, WV 25951 cd�tmiggicin expires October 12. 2016 ..o.,�..�..�. ....._ -- .-..�».�,�.� .✓� _. — - - . -- - ----- - � � � -/� �� 111�?�INIA �aROVE �i'�RRACE F!RS�" ADDlTI�R� ' PINEL�AS COUI�;TY, FLORIDA .ba.:..� da:�:a.on oC Qv�e ac w.+ sE•�. o\ 4ti e.w v� o\ s4�, s,<wv. n.9 v�9'v, v�eC. 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DEOICATION `T¢ .. 2sc<.q a3. �z.� cn.Ev..�.a �..L \:.a w.'`a chy\�:a Evaa.._ o a�a�...o�a c,�,.,�� c..L\.'.s �.: ` �i \c.�c �Y.`vc�`c�c� dy ��:�y �.��. �h y ��. �ti a s o� v�.0. e�•.� aQK� 5¢a e�oQ��a.,, >s.a, a�.4 a�yti �ey a�a�. �Q �o �� a d�:� .� y�.�� a�...� o�a �o�5�.a �.o.,.�.. a.. z�.:m p� !. 1 c �///J �_.`.�-CJ-^.�A_ �� i�iy i(/ � 7�-' i`n M.EVa�a � �'�� we.-a .�¢v —�•y/�J .��a.�,_L -7+C�C.,,... %i .h .�i p��.y��:s E o..a ti�Q� w.`...�� . � . � _ � 4 _�-_,.�� 3---_�`� W �� w.��s � ACKNOWLEDGMENT s� � �� c�e�,L-. cd.. �y �@ P:....�os � h� \+y cc�\ Cy F�. \ v.. �ti:�� 5�`� �y aE o\ b« �9ss A.o,�� cQ .<.c pQaec�i pccao� \\y 6¢..M.Eve...s oa�a F��.n w:C vt�y\\ s Eva��s o�.a �awu.�L C.Vxca- a h �Y+. !l M- a\Y ` ��e m< K�ow�lo b¢ � P a�e�� e<a t.o a«.. —�ti � aq�:. 9�.h.�.� R v a a�a ��.. o�a v h o� a� �ti �ec ti.o�. a�.eR C�o e¢iti :�-. . a.... �:� sa o..., aa�a � � �t.e . >z> >.,a Q.,.Qe a � �Q.��_ vrti..a�.. ,.,,yti .a o a e�:i.�. � �� .ti< �\� � .-��o:.�. �,�a�uo7 � J�' `~�ll .il) �`%. I C�i ,�.�./ � � � � � �' V I c'. � '^` . Nv`.vryPvS�a�E�a\ e�F\ecw� \ b.-,ya.. �^ .. �. .'� �� Cnv,,.�<.ic,=•-.�.a.�.��;t71P56 . ��y <o.......�.�,.. �xe;,-« J.,�. �-�'l9sc APPROVAL A��e.Qady�ti ao>�ao�cA �yco..�:.�.c��sote:��co.,..�v. F.oc.ac. �:�s �O'� avy aC Ho b<.- �ss c�.o, I l. �! T'� Ca., �y F 9.. ¢� ENG!NEERS CERTIFIGATE 1 \ ticcc:by cc�\.�4�ia�\ a�itis z\'� acy o`` o\�¢c \9SS A.O.\t��v ��ay ... .,..�,.y< o..a �a.,aa ..a .....�.�...�. �,. -..� a � o� •, a. �a o..a Cv.,�� a-.a �a:.......¢.o..._ o« ��.-��, � � I �°,-.�o i�.�.�-�- ��. IR�p_ w.�iy<No.Z�. R2uy,E � �' Hc \46� Sv \V \ . \00 ,j�,�t�� 51� o<_'. ,,�.. :{:,. � .�. ;.'o �'�� . ,:iuSi��.Gi �a�: � �� _� � � F .:J :o ; �' �'/ '•.41Un �C-:: ✓ SE co.-, o` \�a 9Vf Yt a` Sc�. =� ��p. 29 S.�°c. �G E. -'..4j �' S`��E'\ ,.. 7 1712 Grove DR ANX2014-10021 o � � C ear ��12 Grove Drive Zoning: Low Medium Density Re Atlas #: 264A 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 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: PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILIN6 ADDRESS: PHONE NUMBER: EMAIL: $0 TBD Information on Impact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). Kathryn Lohmeyer and Mike C. Lohmeyer 1010 Park Court, Suite C& D, Safety Harbor, FL 34695 727-385-6297 (Mike); 727-580-2660 (Kathryn) mlohmever@tampabav.rr.com; k.lohmever@championrb.com ADDRESS OF SUBJECT 1712 Grove Drive, Clearwater, FL 33759 PROPERTY: PARCEL NUMBER(S): 05-29-16-94338-004-0040 LEGAL DESCRIPTION CURRENT CITYSERV/CES: Virginia Grove Terrace 1�` Add Blk 4, Lot 4 SANITARY SEWER REQUESTEDCITYSERVICES: X SANITARYSEWER (select all that applyJ SOLID WASTE x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtie Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 0 � C ear�vater 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 SITE AREA: PRESENT (COUNTY): Residential Low (RL) REqUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): 0.19 SIZE OF DEVELOPMENT : Existing: 0 Units Proposed: 1 Unit (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? Vacant Lot New Single Family Dwelling ni., 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��• by � �� who is personally known/has /- / , � , produced as identification. ignatur of prop r y owner or representative i � � /� //�G, ; o��"�� •,_ LAVAN DEMETRfUS PETTAWAY otary publie; // ,� ;' My commission expires: Signature of property owner or�resentative My Comm. Expins feo 20, 201e Commissfon #� Ff 091709 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 ° earwater > � � U Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Kathryn Lohmeyer and Mike C. Lohmeyer MAILING ADDRESS: 1010 Park Court, Suite C& D, Safety Harbor, FL 34695 PHONE NUMBER: 727-385-6297 (Mike); 727-580-2660 (Kathryn) EMAIL: mlohmever@tampabay.rr.com; k.lohmever@championrb.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBIECT PROPERTY: NAME: 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: IVAIVI t: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES '�jC NO PHONE NUMBER: PHONE NUMBER: YES ��( NO PHONE NUMBER: F'I-IUIVt IVl11Vlt5tFi: YES PHONE NUMBER: PHONE NUMBER: � 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 knowiedge and authorize City representatives to visit and photograph the property described in this applicati n. � Sworn and subscribed before me this d day of 1�• bY r ' %/ �! who is personally known/has -�� ,( � l.� (�<_b�-1�t .l�IL.Q�� ., produced as identification. SignafuT�-of prop�Yty owner or represen rr� Sign�fure of property owner or, otary publi My commissioFrexpires: � .,a�: N�I�ty Pubtic • St�te ot Florida M� Comm. Exptres Feb 20, 2018 Planning 8� Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 03/13 o Planning & Development Department � C earwater Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Kathryn Lohmeyer Mike C. Lohmeyer 2. That (I am/we are) the owner(s) and record title hoider(s) of the following described property: 1712 Grove Drive, Clearwater, FL 33759 3. That this property constitutes the property for which a request for (describe request): Annexation of 1 residential lot into the City of Clearwater 4. That the undersigned (has/have) appointed and (does/do) appoint: 5 C:� as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 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 e), the undersigned au�hority, hereby certify that the foregoing is true and correct. /� n _ . . � %� L U /1 ! . . n A � _ � rty Property STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS O DAY OF ,��!,(Y/ ' ��`� . PERSONALLY APPEARED DEPOSED AND1-�AYS THAT HE/S Notary Seal/Stamp WHO HAVING BEEN FIRST DULY SWORN LY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. ; o:►""' : :L LAYAN DEMETRiUS PETTAWAY ,� �". :� z Notary PuDlic • St�te ot florid� ota ry P u bl i�'� � '��; Y omm. x i �Fafi2� 2018 ,. �...... Commission * Ff 094709 My Commission Expires: Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, TeI: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 03l13 o Planning & Development Department � C earwater Petition for Annexation � Supplemental Statement PROPERTY OWNER (PER DEED): Kathryn Lohmeyer and Mike C. Lohmeyer MAILING ADDRESS: 1010 Park Court, Suite C& D, Safety Harbor, FL 34695 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 application. Swor/to and subscribed before me this �� day of , e ��v by � t who is personally known/has �� p produced � as identification. of prop�rty owner (individual or a representative of corporation, partnership r other entity) otar pub ic, My commissic� Signa re of co-pro er owner res: � LAVAN DEMETR�US PETTAWAY My Comm. Expires FeD 20, 20�8 Commission �Y fF 094709 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 Prepared By and Return to: Michele Williams Fidelity Nationai Title of Florida, Inc. 28059 US Highway 19 NOrfh, Ste. 100 Clearwater, FL 33761 Fiie No. FT05-13000978 Property Appraiser's Parcel I.D. (folio) Number(s) 05/2 9/16/94338/004/0040 consideration �35,000.00 WARRANTY DEED TH1S WARRANTY DEED dated February 15, 2013, by Virginia F. Allen, a single woman hereinafter called the grantor, to Mike C. Lohmeyer and Kathryn A. Lohmeyer, husband and wife whose post office address is 2618 W Grand Reserve Circle #639, Clearwater, FL 33759, hereinafter called ihe grantee: (Wherever used herein the terms "grantor" and "grantee" inciude all the parties to this instrument and the heirs, legai representatives and assigns of individuais, and the successors and assigns of corporations) WITNESSETH: That the grantor, for and in consideration of the sum of $10.00 and other valuable consideration, receipt whereof is hereby acknowfedged, hereby grants, bargains, sel{s, aliens, remises, releases, conveys, and confirms unto the grantee, all the certain land situated in Pinellas Coun#y, Florida, to wit: Lot 4, Block 4, Virginia Grove Terrace First Addition, according to the map or plat thereof, as recorded in Plat Book 37, page(s) 62, of the Pubiic Recards of Pinellas County, Florida. JUll�CCI LU CdJCtI1CI1W� IBJIfICUV1IJ� IGJCI VaUViIJ a11V iiiilllCt IVIIJ VI IEI.ViV� II ai�'y'. TOGETNER with all the ter�ements, hereditaments and appurtenances thereto belonging or in any wise appertaining. TO HAVE AND TQ HOLD the same in Fee Simple forever. AND the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that ihe grantor has good �ighf and lawful authority to sell and convey said land; that the grantor hereby fully warrants the titfe to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2012. Warranfy Deed (Individual to individual) Rev (��00) IN WITNESS WHEREOF, the said grantor has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in the presence of: i – Vir ia F. Allen Address: 204 Sunnypoint Avenue Oak Hill, WV 2b941 State of MU � � County of�—e The foregoin � s rument was acknowledged bef,�ar/� me this � day of 2��',G+.�� a3 bY ��1��(� �. �C(�-.�r� , fo m nown to be the person(s) described in or who has/have produced as identification and who executed the foregoing instrument and he/she/they ackno�Nledged that he/shelthey executed the same. �yjiciess my hand and official seal in the County and State last aforesaid this �day of � t' , LV�. Warranty Deed (Individual to Individuaq Rev (3I00) MESI � � �'A c+ � N • � �'"•..� ` x 4...� I �1 � OFFICIAL SEAL NOTARY PUBLIC STATE OF WEST VIRGINIA KIMBERLY K. PARMER PARMER LAW OFFICE 104 JAMES STREET HINTON, WV 25951 Cdtttttiid3i(�n expires October 12. 2016 ..._ ...,.. --- _ � .. . _ - - -- -- - ---- - _.._ — . .-.-.w,�.,..�: ✓� � �� L�1'�� 7 � � � � _ � °�'I g � ��as `' � -_z I C =-9j��z�� °Sq�u� � ��y -;;� �� e�r�. C S S�I�'1m !�!RG�NlA GROVE I��RRACE �'!R�T ADDlTI�N PINEL�AS GOUNTY, FLORIDA �a:..� e da:�:s.o.. aC vv�t eV v..�. sE�i. o\ �ti ° o\ S�c. s,<wp. L9 v.s: r.,c, A� Rv� t oC e� zd..:.aoL o�.�� r. v tie�.... e.. o o� �<� �:�.j�.�.o, c ca.,.,. �n.-�s�n �.4�=�aRa•.� o� boo� ?'f c�^�^. 29 =C \\ x �.n� \on Co.,.:�y R ocys'.-. =�Ycc �e tis-�� \�¢.wm.a �o Zm<cc�as o�:�.z o\y DESCRIPTION �; e..�s... a v..< sE �.. eC at.� aw.�, a` ae_.s,�,..�_ z� a, R4 .�c F s..a .-..,.. .va�° ao• m�•w, �o..y �ti s.cv. �:n.. .aa.o E!, :�IV r ��:,�,� �e� v>.a. \!.¢.�c¢ No'\��c:'E �\�.o.o �t. Vc�qC¢ 569�4009'E \\S.O ��.� c¢ NO'\L\S EG6.0 �t..�� „F4 �ya7°>o'o9°w �, �� o o� a� �.O �t., �t ¢�e. T1o°�8�6` E\2C.93 Ct.'� h:.¢ 40 aaat \��4a��<¢ T�89�4ci�4'a �Cl \o� L� ao o<c +_�,��=a9°aoa is _ � 9 v\:�v„3so,o�t„ ��• i_.. �..�».�o�.acw.�z.a-�q\.,�l.z��..ad�a"�o•o�'E.o��\.,4�.�cQao�.a�6'w:�ao.o�t.'.o��.¢sac..:...,4l.x.�c< y 4 __ '.._ .._— �o. 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