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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 /> (s �ature) <br /> J (date) <br /> STATE OF qA1DILkhj5 _ <br /> COUNTY OF _\Y1ptit41J \VQtC' <br /> Personally appeared before me , the undersigned authority, <br /> who after first being sworn by me, affixed his/her signature in the space provided above on this <br /> day of 120 <br /> Notary Public, State at large <br /> My Commission Expires : <br /> Jj <br /> J <br /> r <br /> * * END OF SECTION <br /> 00452 - 2 00452 - Disclosure of Relationships.doc <br /> F'\Public Works\Capital Projects\SR AtA 8 CR 510 Turn Lanes_IRC-9701 \BID DOCUMENTS 2006079\00452 - Disclosure of Relationsnips.doc Rev. 05I01 <br />