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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 /> ( i nature ) <br /> a3 <br /> (date) <br /> STATE OF Florida <br /> COUNTY OF Pol k <br /> Personally appeared before me , the undersigned authority , Jason [ hanharc <br /> who after first being sworn by me, affixed his/her signature in the space provided above on this <br /> 9th day of April , 2003 <br /> Notary Public, State at larg <br /> My Commission Expires : <br /> `` � „, t;iE CHAMBERS SHELFER <br /> % a�� ti1A ,Y P✓o ' <br /> - Commission 0 DD0096710 <br /> a� " Expires 3/312006 <br /> Bonded Ovauph = <br /> ; '���'%•`.�;,;;ao• Florida Notary Assn,, lnm <br /> ..........M..U .... uHu..N.NN.H...NN.U.N.� <br /> * * END OF SECTION <br /> 00452-2 00452 - Disclosure of Relationships <br /> C:WY DoanWtslproje W26Mpe0ficati rwW452 - DiWosuro of Reletio WWs.doc Rev. 05/01 <br />