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.�,` <br /> - - I' 'i...� - <br /> ..��. - , _ �'_ y <br /> . _. <br /> FLORlDp'S,tIEARQUAitTEFPS FOR COlYIMER�11t1 K! .�-H�ti` <br /> - '-- - VENTILATIOH'SYSTE�S"�•� . .. ., <br /> AUTHORI TION FORM <br /> Qualifiers Affidavit <br /> � KNOW ALL MEN that I Michael ubowicki do hereby constitute <br /> � <br /> � and appoint Phil Reyes Roger Beckham (,r�Ge, �ev'►�r� <br /> � Russell Koss Greg Brodmerkel �c.�� (3�-�}. a�'vn�a <br /> � <br /> � my true and lawful attorney-in-fact fo unlimited permit use from the City of Zephyrhills. <br /> 1� <br /> � <br /> Sign ture of Qualifier <br /> 1/'� <br /> State of Florida, County of ' �- � <br /> Sworn to a ' d before me th s� day of��, 20 ( �f , by ��'�k�l ����-�c�,� <br /> Who is rsonally know o me or has produced as identification. <br /> �����dai'D AS y�►����,�r�r <br /> Si ature, Notary Public — State of Flo ida �\�.��Ro,,,,,, >`, <br /> �'���90N EXP/F�. s. <br /> r ev:��5���9�Zp�s' �'��`.f,.. <br /> �,ui� � I�`��'"� y �U� � :O. <br /> Printed, Typed, or Stamped Name of otary (�e��� o'�� m�°� <br /> � . ��k ���;:o� <br /> . <br /> ��'•.� ����:P��; <br /> /',//�o�%A i ie�e�aa�F�ti�' <br />