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Home My WebLink About13-13981 CITY OF ZEPHYRHILLS 5335-8TH STREET . (si3)�so-oozo 1 981 BUILDING PERMIT Permit Number: 13981 Address: 37345 DERBYSHIRE DR Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: WEDGEWOOD MANOR Est. Value: Parcel Number: 10-26-21-0120-00000-0930 Improv. Cost: 6,200.00 Date Issued: 3/15/2013 Name: KIZER, BRADLEY& BEVERLY Total Fees: 70.00 Address: 37345 DERBYSHIRE DR Amount Paid: 70.00 ZEPHYRHILLS FL 33542 Date Paid: 3/15/2013 Phone: 8133956269 Work Desc: REROOF SHINGLE � . V �� k��YG�Cs� � � 1 TAPE JOINTS ROOF INSP FINAL � �Z(�� 3 REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one of the following reasons: a)wrong address b)condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d)work not ready for inspection when called e) permit not posted on job site� plans not at job site g)work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney before rec:ording your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. �s��,.._�._��.�..�A-,_.___ �a CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER / II{III�IIIIIIIIIIII�«IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 261304682? I Permit No. Parcel ID No 1 G � � —� ~ V��2'b �OOCOO "6Q�a NOTICE OF COMMENCEMEhT State o/ �� CouMy ot��w THE UNDERSIGNED hereby gives notice lhat improvement will Oe made to certain resl property,and in accordance with Ghapter 7�3,Florida Statutes, the toUowing InfortneGon is provided ln lhia Nolice of Commencemenl: .r�I 1 Descrip6on of Property: Parcel IdeMificadon No. � ��-Ub-� "'�t Z� `d Q Q 6('J ^��(3� Street Address: � �"{J � 2 h r �" 2. Generel Deacnption ot Improvement �� l ` ��Q `� 3. Owner Uformatian or Leasee infortnaUon if the Lessee contracted for the improvement: � 2� �Li ZeJ(" —.— — ''�`l3y ��a.nsh�rc Or'. ��[.4�.\\S SL Address V i,ity 3�-Z_ Interest in Property: O W Y�G� _— Name of Fee Simple Titlehotder� (If difterenl from Owner listed abcve) Address ^1` (� �� C�c State 4. COntractor. S��'�T ��SS 1.�f1A�AJ� 'Po 'i3a�1�4�C� �'� I�v�o�v�o _ l� Address �c--� �,,` t ��Y 3�b�`,� CoNrectaYS Telephone No. »°�v�~��y� 5. Surety: Name Address City State Amount of 9ond: S Telephone No. 6. Lender - — Name IAddress City Slale , Lendefs Telephone No.. _ 7 P�arsons within ihe State of Florida designated by the owner upon whom rc,tices cr other documenls may be served as p�oviUetl by � * * * Sectlon 713.13(1)(a)(7),Florida Statutes: �• - 'Rept:1504661 Rse: 10.00 � (�'j� • • 6' Neme 4 � 'D5: 0.00 IT: 0.00 r ,•�a�i � -- �03/16/13 B. MoBee, Dpty Clsrk (� � Address C;ry -- acate- � ^ • Teiephone Numbsr o(Designated Person: .-_ — � � °� • '� 9. In addition ta himselt,lhe owner designates °t--- . �, ' � � to roceive a copy of Ihe LlenoYs Notice as prov!ded in Section 713.13(1)(b),Florida Stalutes. O � .'�� _ /� � Telephone Number of Person or Enlity Designated by Owner: _ .;fg � s '� 9. Expiration date of Notice ot Commencement(the expiretion date may not De before tl�e completion of construction and final paymeM t�ihe � �:�.�• , � * conlraUOr,but will be one yezr from fhe date o(record;ng unless a diHerenl date is specified): _ ` ' �, • �' WARNING TO OWNER: ANY PAYMENTS MADE BY TH:OWNER AFTER 1'HE EXFIRATION OF THF NOTICE OF COMMENCEMEN7 -- `"'' - A T 1 SECTION 711.13, FLOkIDA STATUTES, AND CAN ARE CONSIDERED IMPROP�R PAYMENTS UN�ER CHAPI"ER 713, P R RESULT IN YOUR PAYING 1WICE FOR IMPROVEME�:TS TO YOUR F�ROPERTI A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THF_JOB SITE BEFORE THE FIRST INSFcCT10N. IF YOU INTEND TO 09TAIN FINANCING,CONSULT � �-- w Y WITH YOUR LEt1DER OR AN ATTORNEY BEFORE COMAAENCING WORK GR RECURDIN^v YOIIR N0710E OF COMMENCEMENT � z U � � - Lil li � W Under penalty o(perjury,I deGare lhat 1 have read the toregoing notire of ccmmencement and that the tacts stated therein are lrue!o:he hest � Vr `S LL = w U ot my knowledge an4 belief. ' /� i G � ZUln J NQ 1-}- STATC OF FlORl6A d � 0 2 Q N � � i COU�J7Y QF PASCO — Signature o er Les ,or Owner'�;or Lessce.'s Nulhorized O � � Z � a W Iorrcerrnir : lParinedM nager } p � Q Q O F— W � � U�U Signatory:,TiUe�Otfire Z = � 0 � ��_. L �..�L��_��" � �-- a W `L The foregoing lnstrument was acknowled�ed before me this�day of 2C �by_ � F- � � ag _ �(lype ot authwity,e.g.,oKcer,truslee,ettnrrey in fact)for V Z �V z�W ;na:ne party on benalf of wnorn insirument was executed). 0 } U LD U --` Notar Si nature�� u' W � � �' Perso�ally Known C]OR Produce0 Identifica'�nr.C] Y• 9 �,1' LC � � a Z O J Typeoflden!�caPunProduced _ Name(P�mq_�� '�"-�n�"-a-�`� O w � Q � p Z � � � � � 0 ' .3�� F- Z � � (n I ,.`.�p yy4 SCOTT G BLACKMAN �1.� Uy Q J W„� Q s;� Fy NMUY PWIk•Sl4e ol Fb�id� !- W � Z�J f.�' .•3 My Comm.6a+oe Oet 1S,2018 Q � � � � "; F�+ CnmmHWOn�EE 813776 � � � � � � m �4;,;�!,•'_ycM�,A NritoN1 qolp►At� wpJ a Wibcs;noticecemmencement�c05304R FRULfi 5 0'MEII,Nti D PPSGJ CLERK$ LOMPTROLL£R A3/2."�f1:i p10:3�jam 1 of 1 � , OR CK Q�°f�_ FG �0�� 5�� Proposal/Contract sc��t � � � , �I�. ' P. . Box 1188 • 33010 S 52 . O San Antonio, FL 33576 .Ctee�see�, � (352) 588-ROOF (7663) � (813) 782-1330 �s�� & � 1-866-407-0559 • Fax (352) 588-9763 9�s�c�� www.scottblackmanroofing.com �^�°�� email: blackmanroofing@aol.com Date I��.� 1 z z- U�3 �� 05795� PROPOSAL SUBMITTED TO WORKED TO BE PERFORMED AT Name M � � � �J �' l�i��Z P r Street � � S�� o � Street �`)3`��' �i°Y b� � � L� t ,. �✓� City 'L�' CI�/ . �+.L �� 1t@ � �—�n ZIP '3 �L State �r Zip � Ownerof Properry Phone Number � � 3 ' �� b� Phone Number Fax We h�ceby propose to furnish all the materials and perform all the labor necessary for the campletion of: 8 Remove existing shingle roof ❑Rep al ce bad fascia boards at$ � ' U t' per foot ❑ Re ove existing built-up roof ❑Replace 1 x decking at$_ per foot �f Dry-in with ❑ 15 Ib. A'30 Ib. ,�tall !.' feet of ridge vents � ❑Dry-in with a fully adhered underlayment$ ❑Install modified bitimen (granulated)torch down roofing ❑Ins I new galvanized valley metal additional black, white or other color Install new lead boots ❑ Install 25 yr.fungus resistant 3-tab shingles . I�nstall new roof jacks rd"Install��ngus resistant dimensional shingles � ''�'``�`r ,�� o'Instatl new drip edge, �,k�,✓� �k color ❑Shingle manufacturer color ❑Install new flashing as needed ❑Install TPO,white rubberized roofing membrane �TRe I ce I ood at$ / �' v" er � �p p Yw p sheet ❑Other: Z. :S'�-u.-�S ,� �� W$.;� � n��.�; -�Repair rotten trusses at$ .3 '"'� perfoot y� ,-„�, '� C �;� ,^ . .� �� ,� *Woodwork is an additional charge,see ricin above +— ' � p 9 C �•• � S ,�i,,,- (.vv� �b.-.,4 h�`L�Z i All material is guaranteed to be as specified,and the above work is to be performed is accordance with he drawings and specifica- tions submitted for above work and completed in a substantial workmanlike manner for the sum of$_ �v` u� witn payments to be maae as fouows: Payment due in full on com�letion, unless otherwise noted. Thank You. Credit cards accepted,additional 3%charge. "Not responsible for satellite signal when satelite is reinstalled 'Not responsible for C & electrical lines rtoo close to roof decking Any alteration or deviation from above specifications involving extra costs will _ ��y%Y,��`v� be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays Officer/A ent Scott Blackman Roofin beyond our control.Owner to carry fire,tomado and other necessary insurance 9 9 upon above work.Workers'Compensation and Public liability insurance an above NOtE: ThIS proposal may be withdrawn by us if not aceepted work to be taken out by Roofing Contractor. Extreme caution should be used durfng and after construction for debrls and nails missed during within days. cleanup. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.I have read the back of this Proposal/Contract,which contains Florida Statues 713.001-713.37.Payment will be made as outlined above. Client gives permission to drive on driveway to deliver m ials. ; �.�- Accepted4.��J� ��y ��E?r2- Signatu e �� , Date C�'i�—%o�- ,.��l� , Signature s�s-�ao-oozo City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Phone Contact for Permittin 3SZ .._ �j � Owner's Name �C,.Ve!'" ��1 '2..�r' Owner Phone Number � l S - �,Z(, Owner's Address 3�3`-f�5 l7er Sh�1rLQt; �t ✓{�•QS Owner Phone Number C Fee Simpie Titleholder Name Owner Phone Number C Fee Simple Titleholder Address JOB ADDRESS ��S L7Cr S�'�►'t �f Z I� <«S��L 3`3 ^ LOT# �� SUBDIVISION W� W PARCEL ID# ��2-10-"Z�..Q�'Zp« OG G�U « �g 38 (OBTAINED FROM PROPERTY TAX NOTICE) 1NORK PROPOSED B NEw CONSTR e ADD/ALT [� SIGN Q (� DEMOLISH INSTALL REPAIR PROPOSED USE � SFR Q COMM � OTHER �— TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q � DESCRIPTION OF WORK �CraU'F I"t4� �- P�'�1^�^'�'� TI��'.,Lt��t%�t, BUILDING SIZE SQ FOOTAGE�� HEIGHT �� QBUILDING $ VALUATION OF TOTAL CONSTRUCTION � � 1Z��,� DELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY C] W.R.E.C. OPLUMBING $ QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �GAS Q ROOFING SPECIALTY 0 OTHER FINISHED FLOOR ELEVAT�ONS FLOOD ZONE AREA QYES NO BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C PLUMBER � COMPANY _� SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C MECHANICAL � � COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C OTHER 5c'$� �� COMPANY SCo�}" D�,GSL..�I�Q�ti ��-cxr'T-l� �.�-� SIGNATURE /61+��^- REGISTEREO Y/ N FEE CURRE� Y I N Add�ess License# C—�CJ s�`�7 5� RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities 8 1 dumpster;Site Wor1c Permit for subdivisionsAarge projects COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities 8�1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engfneered Ptans. ""PROPERTY SURVEY requ(red for all NEW construction. Directions: Fill out application completely Owner&Contractor sign back of application,notarized If over s2500,a Notice of Commencement is required. (A/C upgrades over 57500) "" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (front of Apptication Only) Reroofs if shingles Sewers 9ervice Upgrades A/C Fences(PIoUSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for comp�iance with any - applicable deed festr�ctions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be Iicensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privjleges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "ce�tificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713, F)orida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner" prior to commencement. CONTRACTOR'SIOWNER'S AFFID�4VIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone"V" unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted bui�ding using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shatl issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Eve,ry permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. .An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYI YO RILENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.' CONSULT WITH FLORIDA JURAT(F S. 117.03) � CONTRACTOR �"��—'��'�'� OWNER OR AGENT� ub ribed and sworn to(or affirmed)before me this Su�scribed and sworn to(or a irmed)before me this �_��_� 3 by .3-�5'{�J by Who is/are personall known to me or has/have produced Who is/are personally known to me or ha asadentific�ation. as identification. i � \ � ,� _ ` � �� Z�Notary Public ='?�y� '� Notary Public � �^� ;� *'� JACQUELI BOG�ES Co sfon'N{�`,1 •-. JACQUE Commis�ioF►'No. �_ ,� � ' . • � :•: rrbssion#EE U40520 � =;,,� ` Expres December 12,2014 ,.' .; ..; :;,; �res ��s Name of Notary type ,� ' � Name of Nctia►�t:�(p,�� Pasco County Parcel: 10-26-21-0120-00000-0930 001 Page 1 of 2 Data Current as Of: Weekly Archive - Saturday, March 09, 2013 Parcel ID 10-26-21-0120-00000-0930 (Card: 001 of 001) Classification � 01 - Single Family Mailing Address Property Value BECK NORMA E DECEASED Ag Land �o 37345 DERBYSHIRE DR Land �15,ao1 ZEPHYRHILLS FL 33542-7962 Building $69,ias Physical Address Extra Features $359 37345 DERBYSHIRE DR ZEPHYRHILLS FL 33542-7962 �ust Value $84,948 Leqal Description (First 4 Lines) Assessed (Non-School Amendment 1) $84,948 See Plat for this Subdivision Homestead Exemption applied for 2014 WEDGEWOOD MANOR PHASE I & II PB 27 PG 11-14 Taxable Value ;8a,9a8 LOT 93 OR 3809 PGS 950-952 Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Condition Value � 0100 SFR OOR4 4,140.00 SF $4.65 0.80 $15,401 Additional Land Information Acres 0.10 Tax Area 30ZH FEMA X500 Residential Code WDGWLPI Code Buildinq Information - Use 01 - Single Family Residential (Card: 001 of 001) Year Built 1992 Stories 1.0 Exterior Wall i Above Average Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle n � � Interior Wall 1 Drywall Interior Wall 2 None :� � Flooring i Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air- Ducted A/C Central Baths 2.0 Line Description Sq. Feet Repl. Cost New 1 BAS 1,434 $76,504 2 FGR 340 $7,256 3 � FOP � 20 � $267 Extra Features (Card: 001 of 001) Line Description Year Units Value � 1 DWSWC 1992 181 $265 2 CON PTO 2003 50 � $94 Sales History Previous Owner CARLSON MILDRED L EST OF Month/Year Book/Page Type C de Condition Amount Executor's Deed 09/1997 3809 / 0952 (Personal Improved $76,000 Representative's) �-��-, http://appraiser.pascogov.com/search/parcel.aspx?sec=10&twn=26&rng=21&sbb=0 l20&b... 3/15/2013 Mike Wells Ori inal 2014 Application forAd Valorem Tax Exemption Pasco Countv Propertv Appraiser http:llappraiser.pascogov.com PAS-PA501 14236 6th St,Ste 101,Dade City,Florida 33523-3411 Dade City(352)521-4433 R-�Z�Z • FGORID� Land O'lakes(813)929-2780 New Port Richey/Gulf Harbors(727)847-8151 Homestead Application Type INIT � Parcel Identification Number Cards HX card Use Mo HWDV Pct N N=New,C=Change,A=Additional CL___ 10 26 21 0120 00000 0930 001 001 _ 01 01 pe�manent FL residency required as of Jan 1 Name and Address _M Marital Status:S,M,W, R, D,U Use codes:A,C,O,B,or T KIZER BRADLEY J SR&BEVERLY J N Are you receiving any residency B Homestead Exemption up to$50,000 required exemptions anywhere g500 Widow's exemption 37345 DERBYSHIRE DR N Rec'd Homestead within last 2 rs? __ y $500 Widower's exemption ZEPHYRHILLS FL 33542 If"YES"where: _$500(Disability)Regular Physical Address -- $5000(Disability)Service 37345 DERBYSHIRE DR ------------ i$5000 Surviving Spouse Notes If"NO",your last years address —$500 Blind persons exemption DRAKE CT-BLUEJAY MHP The following require documentation PF-11 DADE CITY FL � Total 8 Permanent disability PASCO RENTED �exemption,Quadriplegics Ownership Information _Service connected total and Legal Description permanent disability exemption Percent of Ownership 100 Disabled veterans confined to WEDGEWOOD MANOR PHASE I&II Deed date 01/14i2013 ---Wheelchair PB 27 PG 11-14 Deed notary date 01/�4i2013 Total and ermanent disabili LOT 93 Deed recording date 00/00/0000 — p �� OR 3809 PGS 950-952 Type of deed WD ` limited income OR Book and Page 0000-0000 —Surviving Spouse first responder NOTE.Disclosure of your Social Security number is mandatory It is required by section 196.011(1),F'lorida Statutes.The Social Security number will be used to verity taxpayer identity information,homestead exemption informatian submitted to property appraisers and intangible tax information submitted to the DepaRment of Revenue. Applicant last name first MI Co-applicant last name first MI Other applicant last name first MI Proof of residence for all owners KIZER BRADLEY J SR KIZER BEVERLY J Social Security No.and H,W,or O code H �--'---y�/ v--^�_��—_ Give address for each owner not residing on above referenced property �^ � Phone number (813)395-6269 (813)395-6269 Date you became a pertnanent resident ^ V of the State of Plorida 00/00/2005 00/00l2005 Date ofoccupancy 01/14/2013 01/14/2013 Florida Drivers license number K260070360240 K260070369160 Issue date on drivers license 11/30/2011 11/01/2011 � � � Date of Birth 01/24/1936 11/16/1936 � Florida vehicle tag number AQGV68 N/A Florida voter registration number PASCO PASCO Date of registration 00J00/0000 00/00/0000 ^ � Immigration number-or-Alien Card N/A N/A Issue date -- —- -- -- ------------ ---------- Declaration of domicile(OR and PG) N!A N/A ` Date of registration ----- -- — -- ----— — --i-----�------l�- Previous Location � Current Employer RETIRED RETIRED Address listed on your last IRS return DRAKE CT-BLUEJAY MHP DRAKE CT-BLUE.IAY MHP DADE CITY FL DADE CITY FL. � � RENTED RENTED ` � � Location and number for out of state or � foreign country drivers N/A N/A N!A N/A ___ __ `_ __ Location and�umber for out af state or N/A N/A N/A N/A foreign country vehicle registretion ----- ------ —---- -- -- - ----------------------- I hereby authorize this agency to obtain infortnation necessary to determine my eligibility for the exem�tion(s)applied for Note:If all informatian is not received by March 1st,your applicatian will be processed for whatever exemptions you qualify for on that date.I hereby make application for the exemptions indicated and affirm that I do qualify for same under Florida Statutes.I am a permanent resident of the State of Florida and I own and occupy the property described above. I understand that section 196.131(2)Florida Statutes provides that any person who knowingly and willfully gives false information for the purpose of claiming homestead exemption is guilty of a misdemeanar of the first degree,punishable by a term of imprisonment not exceeding t year or a fine not exceeding$5,000 or both.Further,under penalties or perjury,I deGare that I have read the foregoing application and the fads in it are true.F.S.196.031 Exemption of homesteads--(5)"A person who is receiving or claiming the benefit of an ad valorem tax exemption or a tax credit in another state where permanent residency is required as a basis for the granting of that ad valorem tax exemption or tax credit is not entitled to the homestead exemption'provided by this section." �� a�`�" � ��.�. Signature of applicant Signature of Co-applicant Signature of Other Applicant Signature of Deputy 2/20l13 12:02:29 PM 2/20l13 12:03:07 PM 2/20/13 12:03:20 PM C This application must be filed with the property appraiser on or before March lst. The information contained in this application will be provided to the Department o(Revenue and t6e Department and/or t6e property appraisers are authorized to provide this ioformation to any state in which the applicaot has previously resided,pursuant to 196.121,Florida Statutes.Social Security Numbers will remain confidential pursuant to secNons 193.114(5)and 193.074,Florids Ststutes. NoNce: A tax lien can be imposed on your property pursuant to 196.161,Fiorida Statutes. Section 196.161(1)provides: (1)(a)"When the estate of any person is being probated or administered in another state under an allegation that such person was a res�dent of that state and the estate of snch person contains real property situate in this state upon which homestead exempt�on has been allowed pursuant to s. 196 031 for any year or years within 10 years immediately prior to the death of the deceased,then within 3 years after the death of such person the property appraiser of the county where the real proper[y is located shall,upon knowledge of such fact,record a not�ce of tax lien agamst the property among the public records of that county, and the property shall be subject to the payment of all taxes exempt thereunder,a penalty of 50 percent of the unpaid taxes for each year,plus 15 percent mterest per year,unless the circuit court havmg jurisdiction over the ancillary administration in this state,determines that the decedent was a permanent resident of this state during the year or years an exemption was allowed,whereupon the lien shall not be filed or,if filed,shall be canceled of record by the property appraiser of the county where the real estate is located.(b) ]n addition,upon determination by the property appraiser that for any yeaz or years within the prior 30 years a person who was not entitled to a homestead exempt�on was granied a homestead exemption from ad valorem taxes,it shall be the duty of the property appraiser makmg such determination to serve upon the owner a notice of intent to record in the public records of the county a notice of tax lien against any property owned by that person in the county,and such property shall be identified m the notice of tax lien. Such property which is situated in this state shall be subject to the taxes exempted thereby,plus a penalty of 50 percent of the unpa�d taxes for each year and ]5 percent mterest per annum.However,if a homestead exemption is improperly granted as a tesult of a clerical mistake or omission by the property appraiser,the person improperly recervmg the exemption shall not be assessed penalty and mterest. Before any such Len may be filed,the owner so notified must be given 30 days to pay the taxes,penalties,and interest. � Closing Affidavit (Buyer) Before me, the undersigned authority, personally appeared Bradley J. Kizer, Sr. and Beverly J. Ilizer, husband and wife ("Affiant"),who being by me first duly sworn,on oath, depose(s)and say(s)that: 1. Bradley J. Kizer, Sr, and Beverly J. Kizer, husband and wife ("Buyer"), is purchasing the following described property from Norma Lee Golembiesky,a married woman,("Seller"),to wit: Lot 93, Wedgewood Manor - Phase I & II, according to the map or ptat thereof as recorded in Plat Book 27,Page 11 through 14,inclusive,Public Records of Pasco County,Florida. 2. Buyer's marital status as reflected in this affidavit and the other closing documents is true and correct. The Buyer is of legal age and has never been adjudged incompetent. There are no matters pending against the Buyer that could give rise to a lien that would attach to the property prior to the recording of the interests to be insured, ancl Buyer has not and will not execute any instrument (nor permit any action to be taken) that would adversely affect thf; title or interests to be insured. There are no judgments or liens against Buyer and no bankruptcy proceedings are currently pending with respect to Buyer. 3. To the best of Buyer's knowledge, information, and belief: (a)within the past 90 days there have been no improvements, alterations, or repairs to the above described property for which the costs thereof remain unpaid, and that within the past 90 days there have been no claims for labor or material furnished for repairing or improving the same, which remain unpaid; (b)there are no actual ar potential mechanic's,materialmen's, or laborer's liens against the property; (c)there are no tenancies, leases or other occupancies (oral or written) affecting the property; (d) no other person or entity has any contract to purchase,option to purchase,right of first refusal,or other potential claim of right to purchase the property. 4. Buyer knows of no violations of municipal ordinances pertaining to the property, or any action or proceeding relating to the property which is pending in any court, nor does the Buyer know of any judgment, tax lien, or matter of any nature whatsoever which could create a lien or charge upon the property. Buyer has no knowledge of a�iy matters that could or does create a cloud on the title to the subject property. 5. There are no matters pending against the Buyer that could give rise to a lien that would attach to the property between the effective date of commitment and the recording of the interest to be insured. Borrower has not and will not execute any instruments that would adversely affect the interest to be insured. 6. There are no actions or proceedings now pending in any State or Federal Court to which the Buyer is a party, including but not limited to,proceedings in bankruptcy,receivership or insolvency,nor are there any judgments,bankruptcies,liens or executions of any nature which constitute or could constitute a charge or lien upon said property. 7. This affidavit is given for the purpose of clearing any possible question or objection to the title to the above referenced property and, far the purpose of inducing Meridian Title Company, Inc. and Old Republic National Title Insurance Company to issue title insurance on the subject property, with the knowledge that said title companies are relying upon the statements set forth herein. 8. Buyer hereby holds Meridian Title Company, Inc. and Old Republic National Title Insurance Company harmless and fully indemnifies same(including but not limited to attorneys'fees,whether suit be brought or not, and at trial and all appellate levels, and court costs and other litigation expenses) with respect to the matters set ,forth herein. "Affiant", "Seller" and "Buyer" include singular or plural as context so requires or admits. Buyer is familiar with the nature of an oath and with the penalties as provided by the laws of the United States and the State of Florida for falsely swearing to statements made in an instrument of this nature. Buyer has read, or heard read, the full facts of this Affidavit and understands its context. File Number•13-02-OSGF DoubleTime� Under penalties of perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it are true. Bradley J.Kizer, Sr. Beverly J.Kizer State of Florida County of Pasco The foregoing instrument was sworn to and subscribed before me this 14th day of February, 2013 by Bradley J. Kizer, Sr. and Beverly J.Kizer,who[� are personally known or[X)have produced a driver's license as identification. [Notary Seal] Notary Public Printed Name: My Commission Expires: Closing A�davit(Buyer)-Page 2 File Number�13-02-OSGF DoubleTime� SURVEY HOLD HARMLESS (NO SURVEY REQUIRED) �,�� J� . ... --� - Seller• Norma Lee Golembiesky, a married woman, individually and, as First Saccessor Sole Trustee of theTrust Agreement of Charles E. Beck and 1Vorma E. Beck, under Trust Agreement dated September 24, 1997 as amended by First Amendment to Trust Agreement dated July 31,2006 to the Trusi Agreement of Norma E.Becic Buyer: Bradley J. Kizer,Sr.and Beverly J.Kizer,husband and wife �• Property: 37345 Derbyshire Drive,Zephyrbills,FL 33542 �Ctosing Agent: Meridian Tit1e Company,Inc. Closing Date: February ,2013 F'ile Number: 13-02-OSGF Norma Lee Golembiesky, a married woman, individually and, as First S}uccessor Sole Trustee of theTrust Agreement of Charles E.Beck and Norma E. Beck, under Trust Agreement dated September 24, ]997 as amended by First Amendment to Trust Agreement dated July 31,2006 to ihe Trust Agreement of Norma E.Beck,the uadersigned seller and Bradley J.Kizer, . _,� �Sr.and Beverly J.Kizer,husband and wife,the undersigned buyer in the closing held by Meridian Title Company,Jnc.on the property described as fotiows: Lot 93, Wedgewood Manor-Phase I&1I,according to the map or plat thereof as recorded in Plat Baok 27,Page 11 through 14,inclusive, Public Records of Pasco County,Florida. Commonly known as: 37345 Derbyshire Drive,Zephyrhills,FL 33542 . Do hereby state that we elected to close without a survey on the property. We hereby release Merid�an Title Company, Inc. and Old Republic National Titfe Tnsurance Company of any liability or expense as a result of not having a survey at the time of closing and shall forever hold them harmless. Buyer: �� Bradtey J.Kizer,Sr. Beverly J.Kizer Seller: �//�U-t i�>-r�. -�� -,��cr,.�� .� Narma Lee Golesnbiesky,individually and as First Suc r Sole Trustee ofthaTrust Agreement of Charles E.Bec d Norma E.Beck,under Trust Agreement dated September 24, i 997 as amended by First Amendment to Tr�st Agreement dated July 31,2006 to the Trust Agreement of Norma E. Beck - .:�� ` ��F.� DoubleTime� � .��,��,K : Closing Statement Addendum Seller• Norma Lee Golembfesky,a married woman,individually and,as Nirst Successor Sole Trustee of tbeTrost Agrcement of Charies E. Beck aad Norma E. Bcek, uuder Trast Agreement daled September 24,1997 as amended by Firs!Amendment to Trust Agreement dsfed July 31,2006 to the Trust Agreement oiPIorma E.Beck Buyer. Brad[cy J.Kiur,Sr.sad Beverly J.Kizer,dusband and wife Properry' 37345 Derbys6ire Drlve,Zephyrbitls,FI.33542 '�*;�;;,,.�.,..,�. , , Closing AgenG MerSdian Title Compaay,Inc. Closing Date: File TJumber• ]3-02-05GF TAX RE-PItORATION AGREEMF.NT:If tho most rocent proparry tax bill issuad does riot cover through the closing date, then tfie tax prorallons set forth on the settlement siatement are bascd upon an estimat�, The basis ofproration as set forth on the settlement statamant is hereby acceptad by the partios to this transaction. It is hereby understood and agreed that the actual iaxes,if difforent,will be adjusted betwesn the partios upon dcmand. Clasing Agent is not liable or responsible for adjwrtment or re-proration of taxes. Closing Agani is not responsibk or liable for additional taxes, other charges oT tax ��'°°"°T'�'"tl�`�`'t� tefunds,if any,and shall not be liablc should any ofthe parties to this transaction faii or refuse to re-prorate the taxes. AGREEMENT TO COOPERATE:If requcsted by l.ender(if any),Closing Agent,Title Agent or Title UndeTwriter,tl�e parties agree to fully cooperate and adjust for cicrical errors, including the execution or m.execution of any reasonable documentation and/or the romittance of any additiona)sums. HpMEOWNER'S/CUIVDOMINIUM ASSOCIATTONS:The BuyeKs)acknowledge(s)the existenco of any homeowneYs and/or condominium association(s)and is aware that monthly,querterly or annua{mainbenance assessments may be due to said associarion(s). Said associalion(s) may also have the suthority to regulate and enforce community covenants and restrictions. The Buyer hereby acla�owledges receipt of a copy of any association estoppel letoers for the subject transaction. ,.,..ri�w,��w....,... M13CELI.ANEOUS.Closing Agent does not make any represantations or warranties nor assumas any liability with respect to the physical condition of the property,or airy repairs to the properry. Buyer has baen advised and encouraged to secure hazard insurance coverage prior to completion of closing. 1f e survey was prepared for the subjdct transaction,then the Buycr hereby acknowledges receipt of a copy thereoC 'Tha buyer has reviewed seid survey and acr,epts Htle subject to the matters set forth thereon. Buyer has received and reviewed the proposed doad and is satisfiod with ar�d approves the manner which title is being held. DISBURSEII�NT Ai1TFiORtZATION,STC.:Closing Agent does not adjust or assurne liability for charges for water, ronts,gas,electriciry,texes on personat properry,gazbage taxes or fecs,license fees or taxes,servicehnaintenance contracu (pest control,appliance maintenancq pool care,lawn care,alarm systems,etcJ,association assessments or dues,or estoppel �� , , ��*—��° � �- infom�ation fi�mished by mortgagees or others. The sattlement statement has bean reviewed and approved and Clasing Agcnt is irrevocably authori�sd and directed to complete the closing of the transaction and mukc disbwsemeat in accordance therewith. in the event of mortgage assumption,if Sellor has roceived a credit for the escrow account balance,then Seller hereby assigns all�ght,titic and inte�st in said account to Buyer. SeNer,Buyer,and Borrower are used for singular ar plural,as the conte�ct so requ'ves or admits. This Agreement is boing provided as an inducement for Closi�g Agent to serve as the closing agent and for Title Agent and Tftle Underwriter to issue tiUe insuranco on tha subject transaction. INTSREST ON FSCROW DISCLOSURE: The Florida Depaztrnent of lnsurance has authorized undor Rule 4186.008 (3),F,A.C.to have an interact bearing ascrow aecount with Buyer(Borrower)aad,if epplicable,Seilers consent. 7nteresi reccived by MerSdian Title Company,Inc.helps de6ay axpenses associated with the closing and eacrow disbursemonts thus r�:K� maintaining lower costs for our cusiomers. Tho undersigned hereby consent to theu funds passing through an interest bearing escrow account. Buyer: Bredley J.Kizer,5r. Beverly 7.Kizer ��.�r�,»..�.. Sel)er � ,��7� � �G�?/)"��Z.. %(�--2. � -L. � Norma Lee Golembiesky individually and,as First Successor Sole Trustea of theTrust Agreement of Charl . Beck and t�ortna E.Beck,under Trust Agreement datod September 24,I997 as amended by F'vst Amandment to Trust Agreoment datod July 31,2046 to the Trust Agcement ofNorma 6.Beck "T- ,:�„��c::.aat. - Oouble7imee Meridiaa Title Company,Fnc. 37837 Meridian Avenue Saite 100 Dade City,Florida 33525 ��:;,�,r,- 352-567-1241 Purpose of this Notice TiUe V of tha Gramm-[.each-Blilay Act(OLSA)generally prohtbits any financial institution, direcUy or through its affiliates,from sharing nonpublic personal information about you with a nonaffiliated ihird paRy unless the institution provides you with a notico of its privacy policies and practices,such ss the type of information that it collects about you and the categories of peisons or entiiies to whom it may be discbsed. In compliance with the GLBA,we are providing you with this document,which notifies you of the privacy policies and }xactices of Old Republic Nationai Tide lnsurance Company end Meridisn Title Compsny, `--�w. '-''�',y- Inc. We mey coliect nonpublic personai information ebout you from tha following sources� • information we receive from you such as on applications or other forms. • information about your transactions we securo ffom our files,or from our affiliates ot others. • Information we raceive from a consumer reporting agency. • Tnfomiation that we receive from othars involved in your iransaction,such iu the real estate agent or lendet. Uniess it is specifically stated otherwise in an amended Privacy Policy Notice, no additional nonpublic �r�p,g�;;,;.,. .,. persona]information will be collected about you. We may disclose any of the above information that we collect about our customers or fortner cusiomers to our affilistes or to nonaffiliated thud parties as permitted by Iaw. We also may disclose this infortnation about our customers or Former ctutomers to the following types of rtoaaffiliated companies that perform marketing services o� our behalf or with whom we have joint marketing agrcementa: • Finaneial serviee providers such as wmpanies engaged in bankmg,consumcr financc,securipes and insurance, "�_^!a�,^�.��-. • Non-financiai companies such as envt}opa stuffers and other fulfi)Imont servie:e providers. WE DO NOT AISCIASE ANY NONPUBLTC PERSONAL fNFORMATIO}�i ABOUT YOU 9✓TTH ANYONB FOR ANY YURPOSE THAT tS NOT SPECIFICA4LY PERNfITTED BY I.AW. We restrict eccese to nonpublic personal inforniation sbout you to those amployees who need to know that information in arder to provide producfs or serviees to you We maintaia physical, electronic, and procedural safeguards that compiy with federal regula6ons to guard your nonpublic personal information. I/Wo acknowledga receipt of"Purpose Of 7'his Notice",oxplaining how Meridian�Title Company,Inc.and Old Republic National TiUe tnsurance Company protects and uses personal information. ��--� �a Dated: Rebruaty ,Z073 ��"l//�ZQVG.r-L ��Y��-� .-,� ocma Leo Golembiesky, individualiy and 'ast Successor Sole Trustee of theTn�st Ageemeni of Charles E. 8eck and Nartna B. Beck,under Trust Agreement dated Saptember 24, 1997 as amended by First Amendment to Trvst Ageement +ated July � • _ -�.�.;-.�- 3 i,2006 to the Trust Agreement of Norma E.Beck . (Seal) fSeal) B►adley J.Kizer,Sr. Beverty J.Kizar " �.x-.r s :,�'m`" ` �oubleTlmes '�� INFORMATION DISCLOSURE 1. The undersigned hereby acknowledge that they have examined the attached cfosing statement and find it to be correct and acknowledge receipt af a copy �f same for their records. ��-:.._ _ . ..2• � The undersigned hereby authorize Meridian Title Company, Inc., to disburse the funds of this transaction in accordance with the attached closing statement. 3. Seller has reviewed and approved the Purchase Money Mortgage and Note, (if applicable) and Buyers arrangements for frre insurance, and liability insurance, (if applicable). 4. Buyer and Seller hereby certify that no real estate commission is due t:o any realtor as a -.. �result of this transaction other than as shown in the attached closing statement. 5. The undersigned hereby acknowledges that the Tax Proration is based upon the prior years tax bill unless the current years tax biil has been issued, and the mortgage lender (if any), and Meridian Tit1e Company, Inc., are not responsible for the accuracy of the proration and any further re-proration of taxes will be made between Seller and Buyer. (Martgage lender in this instance does not refer to Seller.) �- . . „ 6 Charges for water, gas, electric, occupational license or garbage pick up fees are not adjusted as a part of this transaction. Meridian Title Company, Inc., assumes no liability for these items. 7. Buyer is hereby nofified to fiie far homestead exemption, agricultural �xemption, or any other applicable exemption fram ad valorem taxes, as may be applicable under the ��circumstances. In order to file, you must appear at the Prope►ty Appraiser's Office in the County Courthouse where your property is located anytime prior to February 28 of first year follawing the year within which the conveyance takes place. You must take your recorded deed, and each year thereafter, the County wil! notify you of continuing the homestead or other applicable exemption status. Failure to do this will resuit in higher property taxes and increase in your monthly mortgage payments, if taxes are escrowed by your Mortgage holder -�� (if appiicable). 8. Buyer and Sefler hereby agree that any private agreements made by and between the parties herein, will be handled by the Buyer and Seller and that Meridian Title Company, Inc., has no part or responsibility or knawledge regarding said private agreements. Any disagreement or misunderstanding arising from said private agreements wiil be the responsibility of the Buyer and Seiler afone to solve. „� � "° 9. Buyer and Selier hereby certify that al( items and conditions of their contract have been expressly met or waived at the time of final cfosing with the exception of the items listed and referred to in the Memorandum Agreement executed simultaneously with the execution of this document, if any, 10. Closing Agent: Meridian Title Company, Inc., hereby certifies that the attached closing statement represents a complete, true and correct account of funds received and disbursed by us. �� 11. Buyer and Seiler hereby certify that they have reviewed and accepted the title commitment issued on this transaction. �� I/we have read and understand the foregoing disclosure relative to the issuance of a title insurance commitment and/or policy and accepted a copy of same. Bradley J. Kizer, Sr. Beverly J. Kizer °"°� .. . (%��-�'��1-�. G�� .��,� , Narma Lee Golembiesky, individually d as first successor, sole trustee �� CLOSING AGENT: Meridian Title Company, lnc. �_ ., . ��- ..y��. �� -��:::�,.. - a.�`�C�'? �rg�fed by and return to: Gail A.Forester Senior Closer Meridian Title Company,Inc. ��'`��37837 Meridian Avenoe Saite 100 Dade City,F'L 33525 352-567-1241 File Number: 13-02-05TL [Space Above 7his Line For Recording Datal "`� Trustee's Deed ;� This Trustee's Deed made this �� day of February, 2013 between Norma L,ee Golembiesky, a married woman, individually and as first saccessor, Sole Trustee of the Trust Agreement of Charles E. Beck and Norma E. Beck,under trust dated September 24, 1997 as amended by First Amendment to Trust Agreement dated July 31,2006 to the Trust Agreement of]Vorma E. Beck whose post office address is 120 Laurel Place, New Kensington, PA 15068- 49Z6, grantor, and Bradley J. Kizer, Sr. and Beverly J. Kizer, husband and wife whose post office address is 37345 e-��-�,.Derbyshire Drive,Zephyrhilis,FL 33541,as grantee: (Whenever us�d herein the tertns grantor and grantee include all the parties to tfiis instrumcnt and thc heirs,legal representatives,and assigns of individuals, and the successors and assigns of corporations,trusts and trusices) Witnesseth, that said grantor,for and in consideration of the sum TEN AND NO/100 DOLLARS($10.00)and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted,bargained, and sold to the said grantee,and grantees heirs and assigns forever, the follawing described land,situate, �__�Y lying and being in Pasco County,Florida,to-wit: Lot 93, Wedgewood Manor- Phase I& II, according to the map or plat thereof as recnrded in Plat 800k 27,Page 11 through I4,inclusive,Pubiic Records of Pasco County,Florida. 'I'HE PROPERTY BEING CONVEYED HEREiN DOES NOT CONSTITUTE ANY PORTXON OF THE HOMESTEAD PROPERTY OF THE GRANTOR(S)HEREIN. Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining, �...,.:�:: To Have and to Hold,the same in fee simpte forever. And the grantor hereby covenants with said grantee that the grantor is tawfully seized of said Iand in fee simple; that the grantor has good right and lawful authority to sell and convey said land;that the grantor hereby fully warrants the tiile to said land and will defend the same against the lawful claims of al l persons claiming by,through �r under grantors. , �,�, DoubleTtmeae In Witness Whereof,�rantor has hereunto set grantor's hand and seal the day and year first above written, + s,�Sigr►ed,sealed and delivered in our presence: � � . � " Q,1�'1 � � �U�<'_.U��- �/Y?�G�=��'11� �u Wih�es Name:��.a �,�.a �. ,�c.l.(_ Norma I,ee Golembiesky,individually and as Fir ccessor Sole Trustee of theTrust Agreement of l;harles eck and Norma E.Beck,under Trust Agreement dated Sep#ember 24, 1997 as amended by Firsi Amendment to Trust Agreement �w �� dated Ju]y 3 l,2006 to the Trust Agreement of Norma B. Beck s 'a4US 1 •��`"4tr'"""Statc of '° . . � ��{ �.f,A County of_j��fy.��,��.,J� The foregoing instrument was acknowledged before me this �Z� day of February, 2013 by Narma Lee Golembiesky, individually and as First Successor Sole Trustee of theTrust Agreement of Charles E. Beck and Nornya E. Beck, under'I'rust Agreement dated September 24, 199'7 as amended by First Amendment to Trust Agreement dated Jnly 31,2006 to the Trust Agreement of Norma E.Beck who[._:j is personaily known or[X�has produced driver's license as identification. � .�.�,�� .�,� . COMMONWEALTH OF PENNSYLVANIA �� 't��__._____. [Notary Seal] Notarial Seal Notary Public Elizabeth L.Fennell,Notary Public C1ty of New KNWngton,wesmwre�and coun�y Printed Name: �� L- ��,J[,� hi Commission res Oct.16,2016 M@MOHR�OIkNNSYE,yANlA . 1TON OF NOTARIES My Commission E�cpires: Q��(�,. ��_ . .�.„ -,�,,. .;�., � `-xa-.a,;�.:..r•,F . r,.'7�Ib4rt?.x� , ' .,. ...�, . Trustee's Deed-Page 2 DoubleTlmee . .., . _..�, , ..