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Name of Affiliate Name of Count Relationship <br /> P <br /> or Entity Commissioner or employee <br /> 2 . <br /> 3 , Imo' <br /> 4 <br /> 5 . <br /> 6 . <br /> 7 . <br /> 81 <br /> ( signature ) <br /> ( date ) <br /> STATE OF <br /> COUNTY OF v� � , 1 "1% vy 112 e _ V.1==:� — <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 o I`% c ./ e_ rv� - , 20 _ <br /> r y Pe <br /> �' Lt� o�A *{, VICKIE LEGE WRIGHT <br /> �= n Notary Public • state of Florida <br /> Notary Publlc , St to at large My Commiuion Exp, March 11 , 2012 : <br /> My Commission Expires : ` � b�„ } d ,�� Comml> Itin # DD <br /> J <br /> * * END OF SECTION <br /> 00452 - Disclosure of Relationships . doc <br /> 00452 - 2 <br /> FAEngineering\Land Development Permits\Quail Creek PD\Bid - Contract Documents100452 - Disclosure of Relationships . doc <br />