Donation of Property to Fla Dept of Transportation r•
575-030-12
RIGHT OF WAY
Florida Depar°tMent o T'r°ansp®rtataors 06M
RICK SCOTT"
GVNR, 1000 IOW 111 Avenue AtvAtv'I's rRsaD,P.E.
Miami,FL.33172 SECRETARY
Donation of Property to the'Florida Department of Transportation
Fred Beckman,P.E. ITEIWSEGMENT NO.: 4275052
The City Of Ntiami Beach MANAGING DISTRICT: SIX
a'
Public Works Department F.A.P. NO.:. '
N/A
1700 Convention Center Drive STATE ROAD NO.:' AlA(Indian Creek Drive)
.Miami; Beach,Florida 33139
COUNTY: MIAMI-DADE
PARCEL NO.:. 800
•INTEREST CONVEYED: PERPETUAL EASEMENT
This is to advise that the undersigned, as owner of the property or property interest referenced above and as shown on
.Right of Way maps for referenced project,desires to make a•voluntary donation of said property or property interest to the
State of Florida for the use and benefit of the Florida Department of Transportation.
The undersigned hereby acknowledges that he/she has been fully advised by a Department representative of his/her right
to have the.referenced property or property interest appraised,'to accompany the appraiser during the appraisal
inspection of the property,to receive full compensation for the above referenced property,-and to receive reimbursement
for reasonable fees.and costs incurred, if any. Having been fully.informed of the above rights, I hereby waive those rights
unless otherwise noted below.
Owp0ls Signature
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Type or Print Property Owner's Name
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City, State, Zip Code
Q_1 Date
www.dot.state.fl.us