STATE OF FLORIDA LEE COUNTY PROPERTY APPRAISER
STATE OF FLORIDA
LEE COUNTY PROPERTY APPRAISER
MATTHEW H. CALDWELL
P.O. Box 1546 Fort Myers, Florida 33902-1546
Telephone: (239) 533-6100 Website:
AUTHORIZATION TO RELEASE CONFIDENTIAL TAXPAYER INFORMATION
The undersigned, on behalf of _________________________________________ (¡°Taxpayer¡±),
expressly authorizes the Lee County Property Appraiser to permit ______________________
_______________________________________, to receive, inspect and copy all of Taxpayer¡¯s
records in the possession of the Lee County Property Appraiser, including information deemed
confidential by Florida Statutes. Taxpayer acknowledges and understands Florida Statutes
make certain taxpayer information confidential for the benefit of Taxpayer and will hold
harmless and indemnify the Lee County Property Appraiser from any and all claims due to the
release of Taxpayer¡¯s confidential information pursuant to this authorization. The undersigned
represents he/she has authority on behalf of Taxpayer to sign this authorization and intends for
the Lee County Property Appraiser to rely upon this representation.
Name of Taxpayer: _____________________________________________________________
Address of Taxpayer: ___________________________________________________________
Telephone number of Taxpayer: ___________________________________________________
Account number(s):_____________________________________________________________
_____________________________________
Taxpayer¡¯s Signature
___________________________________
Taxpayer¡¯s Printed Name
____________________________________
Title
___________________________________
Date (Valid for 1 year after date signed)
The foregoing instrument was acknowledged before me this ____ day of ____________, 20___,
by ___________________________, who holds the office of_______________________ (title),
who is ? Personally Known to me OR
? Produced Identification.
Type of identification Produced: ______________________________
_____________________________________
Signature of Notary Public
State of: ________ County of: ___________
My Commission Expires: ________________
___________________________________
Printed Name or Stamp of Notary Public
................
................
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