2017-108 INSTRUMENT#: 2017107280 OR BK 5010 PG 1273 PAGES: 3 10/9/2017 3:27 :07 PM
NEIL KELLY, LAKE COUNTY CLERK OF THE CIRCUIT COURT
REC FEES: $27 .00
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Florida Department of Environmental Protection
411A a NOTICE OF LINIITATION OF USE/SITE DEDICATION
4'40 et Si o,u
Required Signatures: k)rieinalInk! iNotarized Sisnature •
Recording Instrument Information:
Park Name: Palatlakaha Park
This Notice of Limitation of Use/Site Dedication gives notice that the Real Property identified in the project
boundary map and legal description,attached hereto as Exhibit"A"(the"Property"),has been acquired by or
developed with financial assistance provided by the Florida Legislature,through the Department of
Environmental Protection,under the following grant programs:
• Florida Recreation Development Assistance Program(FRDAP):
In accordance with section 375.075,F.S.,and chapter 62D-5,F.A.C.,Subsection 62D-5.059 and the
following constitutes the general requirements for program compliance: SITE DEDICATION—"Land
owned by the grantee,which is developed or acquired with FRDAP funds,shall be dedicated in
perpetuity as an outdoor recreational site for the use and benefit of the general public.Land under
control other than by ownership of the grantee such as by lease,shall be dedicated as an outdoor
recreation area for the use and benefit of the general public for a minimum period of 25 years from the
completion date set forth in the project completion certificate.The dedications must be recorded in the
public property records by the grantee."
• Land and Water Conservation Fund(LWCF):
In accordance with section 375.075,F.S.,and chapter 62D-5,F.A.C.,Subsection 62D-5.070(12-16)and
the following constitutes the general requirements for program compliance:SITE DEDICATION-
"Land owned by the grantee,which is developed or acquired with LWCF funds,shall be dedicated in
perpetuity as an outdoor recreation site for the use and benefit of the public.Land which is leased from
the federal government or another public agency by grantee must include safeguards to ensure the
perpetual use requirement contained in the Land and Water Conservation Fund Act.Safeguards include
such things as joint sponsorship of the project or an agreement between the parties that the lessor would
assume compliance responsibility for the project site in the event of default by the lessee(grantee)or
termination or expiration of the lease.These dedications must be recorded in the county's public
property records by the grantee."
DRP-113(Effective 06-12-2015) Page 1 of 2
INSTRUMENT# 2017107280 OR BOOK 5010/PAGE 1274 PAGE 2 of 3
DEDICAT
../ • —.All roir`a elii......amm.
Original signature Witness /
Printed Name: 'V PY S cJA R
Printed Name: Gail Ash
Mayor Witness �1 �
Title: Printed Name:
PAJ
STATE OF FLORIDA COUNTY OF 0L- 6.
The foregoing instrument was acknowledged before me o. *JET Li a ) ( (o/7
by Owl L. ,who*: iersonally known to me o who produced
as identification.
Stamp: �i_. �i / /
t # MY COMMONnt NOAK Notary Public,State o n a
I PIREt mbar 20.2012
@BAttalluudatiallot,yQadoe
DRP-113(Effective 06-12-2015) Page 2 of 2
INSTRUMENT* 2017107280 OR BOOK 5010/PAGE 1275 PAGE 3 of 3
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