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Name of Affiliate Name of County Commissioner <br /> or entity or employee Relationship <br /> (Signature) <br /> SGT tQ q o I <br /> ,—' (Date) <br /> STATE OF 0 C JQ� <br /> � <br /> COUNTY OF `7'T L ( A C <br /> The foregoing instrument was acknowledged before me this g day of r0 �� 22016 b <br /> Y <br /> 4' AW)ey - L F who is pe;,snnal1Y lrnown to me or who has produced <br /> as identification. <br /> NOTARY PUB I <br /> SIGN : <br /> PRINT : IqN7 0 / 64ETTc= <br /> Notary Public, State at large <br /> My Commission Expires : <br /> ANTOINETTE pMRAM <br /> NOTARY PUBLIC <br /> STATE OF FLORIDA <br /> • Comm* EE028292 <br /> ' *'res 9/29/2014 <br /> 00452-2 <br /> R\Engineering\Capital Projects\0107-53rd St, 58th Ave-US #1 \Contract Documents\00452 Disdosure of Relationships ,doc <br />