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SWORN STATEMENT UNDER SECTION 105.08 , <br /> INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS <br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC <br /> OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS , <br /> 1 . This sworn statement is submitted with RFP No . 4046 for <br /> Services for children at Samaritan Center located in Indian <br /> River County <br /> 2 . This sworn statement is submitted by: <br /> William Muir <br /> Catholic Charities of the Diocese of Palm Beach , Inc . ( Samaritan Center ) <br /> (Name of entity submitting Statement) <br /> whose business address is : <br /> 9995 N Military Trail ( PO Box 109650 ) Palm Beach Gardens , and <br /> (if applicable) FL 33410 <br /> its Federal Employer Identification Number ( FEIN ) <br /> is 59 - 2470479 <br /> ( if the entity has no FEIN , include the Social Security Number of the individual <br /> signing this sworn statement <br /> 3 . My name is <br /> William Muir <br /> ( Please print name of individual signing) <br /> and my relationship to the entity named above is <br /> President , Board of Directors <br /> 4 . 1 understand that an "affiliate" as defined in Section 105 . 08 , Indian River <br /> County Code , means : <br /> The term "affiliate" includes those officers , directors , executives , partners , <br /> shareholders , employees , members , and agents who are active in the <br /> management of the entity . <br /> XII <br />