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The entity submitting this sworn statement, or one or more of the officers, directors, executives, <br /> partners, shareholders, employees, members, or agents, who are active in management of the entity <br /> have the following relationships with a County Commissioner or County employee: <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> (Signature) <br /> � G <br /> (Date) <br /> Y <br /> STATE OF <br /> COUNTY OF <br /> The foregoing instrument was acknowledged before me this / qday of - 20 4 9 by <br /> ttj 06 e who is personally known to r who has produced <br /> as idea cation. <br /> NOTARY PUBLIC <br /> SI M7 <br /> PRINT <br /> Notary Public, State at large <br /> F Florida <br /> Wr,) <br /> Patricia A Cannon <br /> eMy Commission DD457000( Expires 10101 /2009 <br /> 216 <br />