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7.Signature of Taxpayer: If signed by a corporate officer,partner,guardian,tax matters Partnerlperson,executor,receiver,administrator or trustee <br /> on behalf of the taxpayer,I certify that I have the authority to execute this form on behalf of the taxpayer. <br /> The following applies N the authorized representative Is a Certified Property Tax Representative pursuant to 50 IAC 15.5.5: <br /> [wImpittelled understand that by authorizing JEFFREY M MCGOWAN as my Certified Property Tax Representative,I am aware of and accept the possibility <br /> at te properly value may increase as a result of filing an administrative appeal with the Property Tax Assessment Board of Appeals,and that I may be <br /> to appear at a hearing before the Property Tax Assessment Board of Appeals or the Department of Local Government Finance. <br /> further understand that the Certified Property Tax Representative is not an altomey and may not present arguments of a legal nature on my behalf, <br /> If this power of attorneyls not signed,dated and notarized,it will be returned. <br /> Signature of taxpayer 1 1 Date of signal mIonfh,de,year) <br /> Printed name of aye, it (i/applicable) <br /> an a. ' �: S,Iuel' <br /> Signature of to yer Date of signature(mc year) <br /> II l�t / <br /> Printed name of taxpayer TNe(if applicable) <br /> 8.Notarization <br /> STATE OF <br /> ��i- J9 OrS-P��/l� SS' <br /> COUNTY OF <br /> Before me,a notary public in and for said state and county,personally appeared,this day of <br /> the taxpayer(s)ore person duly authorized to sign for and on behalf of the taxpayer(s),who acknowledged the execution of this Power ofAttomey as <br /> the voluntary act and deed of the taxpayer(s). <br /> 5ignawr o otary public t county of r sben <br /> Typ/ed�orpriinnni'ed name of n ta,,(ryfpublic !{-�{ J Date co fmio Tres(month,day,year) <br /> Ile- r / °u ,s h , ap aol <br /> PART 11•DECLARATION OF REPRESENTATIVE <br /> Under penalties of perjury,I declare that <br /> I am aware of the statutes,rules and regulations applicable to the matters specified in line 3; <br /> 1 am authorized to represent the taxpayer(s)identified in Part I for the tax matter(s)specified there;and <br /> I am one of the following: <br /> a. Certified Public Accountant-duly qualified to practice as a certified public accountant in the jurisdiction shown below. <br /> b. Certified Tax Representative pursuant to 501AC 15-5. <br /> c. Other(specify) <br /> If this declaration of representative is not signed and dated, the power of attorney will be netumed. <br /> DESIGNATION JURISDICTION(state,etc.)OR <br /> (insert above letter-a,b,or c) ENROLLMENT CARD NUMBER SIGNATURE DATE(month,day,year) <br /> B LEVEL II ASSESSOR F y <br /> Page 2 of 2 <br />