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i <br /> i Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> I <br /> (Signature) wade E . Diekman <br /> 9/21 / 11 Vice-President <br /> l <br /> (Date) <br /> STATE OF Florida <br /> COUNTY OF <br /> Martin <br /> The aforegoing instrument was acknowledged before me this 21 day of Sept. 201 .1., by <br /> Wade Diekman , who is personally known to me or who has produced <br /> N/A <br /> as identification. <br /> i NOTAR PUBLICL Loll <br /> ? <br /> SIGN: <br /> 7 to <br /> ;%I °�9,: ELYZZAH R HEFFERNAN <br /> PRINT ' •"= ION # DD863382 <br /> Notary Public, L< f ge EXPIRES March 24 , 2013 <br /> �- , , , <br /> My Commissio (; " Fforida !JotaryService. com <br /> (Seal) <br /> s <br /> , <br /> i <br /> t 00452-2 <br />