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The entity submitting this sworn statement, or one or more of the officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active <br />in management of the entity have the following relationships with a County <br />Commissioner or County employee. <br />�l oa4 -N <br />(date) <br />STATE OF - ne %& <br />COUNTY OF Y� <br />Personally appeared before me, the undersigned authority,2 C- N +YV4�j <br />who §fter first be�i�rq sy onr ,�by me, affixed his/her si nature in the space provided above on this <br />`; day of �I C.'1yCJJ�I. t'/� , 20 . <br />Notary Public, State at la <br />My Commission Expires: <br />END OF SECTION <br />00452-2 <br />Name of Affiliate <br />or Entity <br />Name of County <br />Commissioner or employee <br />Relationship <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />�l oa4 -N <br />(date) <br />STATE OF - ne %& <br />COUNTY OF Y� <br />Personally appeared before me, the undersigned authority,2 C- N +YV4�j <br />who §fter first be�i�rq sy onr ,�by me, affixed his/her si nature in the space provided above on this <br />`; day of �I C.'1yCJJ�I. t'/� , 20 . <br />Notary Public, State at la <br />My Commission Expires: <br />END OF SECTION <br />00452-2 <br />