Laserfiche WebLink
Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> l � <br /> (Signature) <br /> (Date) <br /> STATE OF lCj . <br /> COUNTY OF L .i� �"�� <br /> The foregoing�g.�.�g inst rLument was acknowledged before me this day of �G� V, Q, 4-Z ;; , 20 ( 1 by <br /> —L 1 �� ``� � , who is personally known to me or who has produced <br /> as identification. <br /> TAR PUBLI <br /> SIGN: <br /> PRINT : 1 <br /> Notary Public, State at 1 e <br /> My Commission Expires : 031 t I ) o <br /> (Seal) <br /> VICKIE LEE WRIof <br /> o 'I' *`�, p�,�ry public • Eti*te of ptortdn <br /> rnmlllan @gyp F,{nrah 11 zn12 <br /> My Ca <br /> >�d0a Gornmlori�r # aC y <br /> 00452-2 <br /> FAPublic Works\ENGINEERING DIVISION PROJECTS\0745-Indian River Blvd Sidewalk Imp . Proj 12th_ 17th St. (LAP )\Admim\bid documents\00452 <br /> - Disclosure of Relationships REV 04-07 . doc <br />