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Name of Affiliate Name of County Relationship <br /> or Entity Commissioner or employee <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5 . <br /> 6 . <br /> 7 . <br /> 8 . <br /> ( Si ture) Jonathan Belloit <br /> June 25 2003 <br /> ( date) <br /> STATE OF FLORIDA <br /> ' COUNTY OF DUVAL <br /> Personally appeared before me , the undersigned authority , Jonathan Belloit <br /> ' who after first being sworn by me , affixed his/her signature in the space provided above on this <br /> 25th day of June 20o_. <br /> ' Notary Pub � <br /> lic , State at rge � 'r <br /> v �, , <br /> My Commission Expires : I � I � I.( �y ` � )R <br /> 1 E, X .1 1:11 <br /> rte.; 1 - 7 - 04 <br /> �;t; 897713 �- <br /> Bl <br /> Ot- �,. <br /> ' * * END OF SECTION <br /> 044572000 <br /> ' 00452 - 2 <br />