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Maurice Smith
cOMPLIANCE W'FFH STATEMEN-F"OF BENEFFFS ~~ ,<~5''''~ ~'-(' ~¢ ~ Ccun~ , ~,000 sq ~t vene=- m~nu ac~ ~g bu~C~9 / ~2 9o ... I v~ues=e~" ==~ ~ -- 1,300 000 I __ ~ ~_~ INSTRUCTIONS: (lC 6- t. 1 · 12. ~,.~vlth, i_n fe~/-Eve (45) days a~ef rscei~* ~ ,~- ,-' .... ~ ~'"~"~'ac'pYoithewn~nnot/c~sh~/lbes~ntt~5~c~.=~L_~-~s~fl~fig~d~ /fanot, rce and (3) the State Board of T~ Co~s~o~e~ y s,,a/i ,m~edi~te~y m~il a cen~t~ad c=~y o~ the te~)~ ~'~g~J;~ll adcct a te~ , (2) ~e [] cmer ~ oe~ermina.~Ion (eNach add/t/cna/~ if necessary/ a,e signed (month, dsM ye~') . - · - "'"~" - - '] " - -;' ...... . - ' The HEARING RESULTS (to be completed afler the h~ar~ . [] Approved Reasons to~r Ce~erminetJe~ additional s,~eets~sary) [] Denied (see instruction 4 above) A~ested by: ! Designating bcC'~- ~j[~]~ --- - .,_ . _. APPEAL RIGNTB [lC E-I.I-I~'1-S,.~(e)~ ' . - ...... ., I ~ property owner whc~,--, ~,=,.~.~-. -- · - - ' ...... ' .......... '~"'