{ "document_id": 12753, "page": 14, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 12864, "item_count": 26, "counts_by_type": { "figure": 2, "footer": 2, "heading": 1, "list": 1, "list_item": 6, "text": 13, "title": 1 }, "build_ms": 2, "items": [ { "id": "p14.1", "order": 1, "type": "figure", "bbox": { "l": 35.28, "t": 768.72, "r": 114.48, "b": 688.8 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p14.2", "order": 2, "type": "title", "bbox": { "l": 119.52, "t": 767.28, "r": 599.52, "b": 725.04 }, "text": "DEVELOPMENT SERVICES DEPARTMENT – ZONING & LANDSCAPING DIVISION\nBOARD OF ADJUSTMENT - AGENT AUTHORIZATION FORM", "attrs": { "block_label": "doc_title" }, "level": 2 }, { "id": "p14.3", "order": 3, "type": "text", "bbox": { "l": 120.96, "t": 710.4, "r": 373.44, "b": 684 }, "text": "Rev: 0 | Revision Date: 01/30/2024 | Print Date: 0/00/0000\nI.D. Number: BOAAAF" }, { "id": "p14.4", "order": 4, "type": "text", "bbox": { "l": 104.4, "t": 658.08, "r": 528.96, "b": 629.76 }, "text": "relating in any way to the City of Fort Lauderdale's reliance of the authority granted to my Authorized Agent pursuant to this Form." }, { "id": "p14.5", "order": 5, "type": "text", "bbox": { "l": 104.4, "t": 614.64, "r": 543.36, "b": 512.4 }, "text": "BY SIGNING THIS RELEASE AND HOLD HARMLESS AGREEMENT, I ATTEST, AFFIRM, AND REPRESENT THAT I AM THE TITLE OWNER/AUTHORIZED PERSON FOR THE PROPERTY AND THAT ALL OF THE FOLLOWING STATEMENTS ARE TRUE AND CORRECT: I am at least eighteen (18) years of age and of sound and competent state of mind at the time executed this Agent Authorization Form; I executed this Agent Authorization Form as an expression of my own free act and deed; There are no oral representations or statements, apart from this Agent Authorization Form and intend to be bound by its terms; and I was not induced by the City, its employees and/or agents, or anyone, to execute this" }, { "id": "p14.6", "order": 6, "type": "text", "bbox": { "l": 104.64, "t": 510.96, "r": 517.68, "b": 482.16 }, "text": "Agent Authorization Form. *Please provide proof of ownership. If the property is owned by an Corporation, please submit Sunbiz Verification with this form." }, { "id": "p14.7", "order": 7, "type": "heading", "bbox": { "l": 107.28, "t": 477.36, "r": 147.12, "b": 464.88 }, "text": "WITNESS:", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p14.8", "order": 8, "type": "list", "bbox": { "l": 108, "t": 462.72, "r": 272.64, "b": 392.64 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p14.8.1", "order": 9, "type": "list_item", "bbox": { "l": 108, "t": 462.72, "r": 272.64, "b": 450.24 }, "text": "Morgan Elliott", "attrs": { "bbox_estimated": true } }, { "id": "p14.8.2", "order": 10, "type": "list_item", "bbox": { "l": 108, "t": 450.24, "r": 272.64, "b": 437.76 }, "text": "Witness Signature", "attrs": { "bbox_estimated": true } }, { "id": "p14.8.3", "order": 11, "type": "list_item", "bbox": { "l": 110.88, "t": 436.08, "r": 271.44, "b": 425.22 }, "text": "Morgan Elliott", "attrs": { "bbox_estimated": true } }, { "id": "p14.8.4", "order": 12, "type": "list_item", "bbox": { "l": 110.88, "t": 425.22, "r": 271.44, "b": 414.36 }, "text": "Print Name", "attrs": { "bbox_estimated": true } }, { "id": "p14.8.5", "order": 13, "type": "list_item", "bbox": { "l": 110.88, "t": 414.36, "r": 271.44, "b": 403.5 }, "text": "1/14/2026", "attrs": { "bbox_estimated": true } }, { "id": "p14.8.6", "order": 14, "type": "list_item", "bbox": { "l": 110.88, "t": 403.5, "r": 271.44, "b": 392.64 }, "text": "Date", "attrs": { "bbox_estimated": true } } ] }, { "id": "p14.9", "order": 15, "type": "text", "bbox": { "l": 359.28, "t": 464.16, "r": 539.76, "b": 436.56 }, "text": "Diana Urbina\nSignature - Owner/Authorized Individual" }, { "id": "p14.10", "order": 16, "type": "text", "bbox": { "l": 362.88, "t": 422.16, "r": 548.4, "b": 397.44 }, "text": "Diana Urbina\nPrint Name - Owner/ Authorized Individual" }, { "id": "p14.11", "order": 17, "type": "text", "bbox": { "l": 362.88, "t": 393.12, "r": 504.24, "b": 366 }, "text": "Sr. Property Manager\nPrint Title - Authorized Individual" }, { "id": "p14.12", "order": 18, "type": "text", "bbox": { "l": 105.6, "t": 360.96, "r": 220.08, "b": 306.72 }, "text": "STATE OF Florida\nCOUNTY OF Bowland\nThe foregoing instrument was acknowledged before me by means of physical presence or online notarization, this day of Jan. 2026 by\nDiana Urbina, an individual who is personally known to me or has produced as identification" }, { "id": "p14.13", "order": 19, "type": "figure", "bbox": { "l": 324.96, "t": 247.44, "r": 483.12, "b": 202.8 }, "text": "", "attrs": { "block_label": "image" } }, { "id": "p14.14", "order": 20, "type": "text", "bbox": { "l": 116.88, "t": 222.48, "r": 284.16, "b": 191.52 }, "text": "ANGELA RYAN\nMY COMMISSION # HH 686261" }, { "id": "p14.15", "order": 21, "type": "text", "bbox": { "l": 107.28, "t": 209.52, "r": 178.56, "b": 193.2 }, "text": "[NOTARY'S]" }, { "id": "p14.16", "order": 22, "type": "text", "bbox": { "l": 322.32, "t": 204.72, "r": 492.72, "b": 135.84 }, "text": "(Signature of Notary Public- State of Florida)\n10-9-2029\nMy Commission Expires:\nPrint./Type. or Stamp Commissioned\nName of Notary Public" }, { "id": "p14.17", "order": 23, "type": "text", "bbox": { "l": 192.72, "t": 200.16, "r": 276.48, "b": 186.96 }, "text": "EXPIRES: October 9, 2029\n(Signature of Notary Public- State of Florida)\n10-9-2029\nMy Commission Expires:" }, { "id": "p14.18", "order": 24, "type": "text", "bbox": { "l": 335.04, "t": 166.8, "r": 422.88, "b": 153.6 }, "text": "Miyela Kymn" }, { "id": "p14.19", "order": 25, "type": "footer", "bbox": { "l": 69.6, "t": 54.24, "r": 122.4, "b": 42 }, "text": "Page 2 of 2", "attrs": { "block_label": "number" } }, { "id": "p14.20", "order": 26, "type": "footer", "bbox": { "l": 155.76, "t": 52.32, "r": 357.84, "b": 30.48 }, "text": "Approval by: Mohammed Malik, Manager Uncontrolled in hard copy unless otherwise marked", "attrs": { "block_label": "footer" } } ], "excluded_furniture": { "first": [], "last": [ { "id": "p14.f1", "order": 27, "type": "footer", "bbox": { "l": 460.8, "t": 54.48, "r": 575.28, "b": 19.2 }, "text": "", "attrs": { "block_label": "footer_image" } } ] } }