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Name of Affiliate Name of County Relationship <br /> or Entity Commissioner or employee <br /> 1 . <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5 . <br /> 6 . <br /> 7 . <br /> 8 . <br /> (signature) �— <br /> GC -F- I Z (3O dq <br /> (date) <br /> STATE OF k= l o r <br /> COUNTY OF =,&kz ..._ F-t, %jAr <br /> Personally appeared before me , the undersigned authority , tot) Jc I <br /> who aftjqr first being sworn bKA <br /> e , affixed his/her signature in the space provided abov6 on this <br /> day of ( ct::ct 'M7 e,e � , 2004 . <br /> • <br /> s <br /> C <br /> otaryublic , State at large <br /> My . . <br /> MOW, AG ES A. HELHOSKI <br /> MY COMMISSION # 00 206636 <br /> EXPIRES: July 29, 2007 <br /> P <br /> END OF SECTION <br /> IRC OPERATIONS COMPLEX 00452 — Disclosure of Relationships <br /> 00452 - 2 <br />