Required by Chapter 373.4149, F.S.
STATE OF FLORIDAFOLIO# ___ - ___ - ___ - ___
COUNTY OF MIAMI-DADE
Before me, the undersigned authority, personally appeared __________________________, Affiant, who being by me duly sworn, on oath, depose(s) and say(s):
As required by Chapter 373.4149(5), Florida Statutes (F.S.), Affiant hereby acknowledges that the subject real property identified above by folio and further described in Exhibit X attached, is located inside, or within two miles of, the Miami-Dade County Lake Belt Area, established by the Florida Legislature in Chapter 373.4149(3), F.S., and further acknowledges the following:
Sworn to and subscribed before me on the ______ day of _______________, yr.: _____.
Affiant is personally known to me or has produced _____________________ as identification.
My Commission Expires:
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