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I <br />N <br />M <br />Name of Affiliate Name of County Commissioner Relationship <br />or entity or employee <br />(S <br />U i�<II <br />(Da e) <br />STATE OF i�� <br />COUNTY OF I—vL.�l� l 1lc <br />The foregoing instrument was acknowledged before me this iz�s day of JA!3 Lk 20 by <br />1 1 WE U ,who is personaJI kJr own to c or who has produced <br />NIA <br />as identification• <br />�pPY PG9 YICKIE LEE WRIGNT '� <br />0 Notary Public State of Florida <br />o ,+ Aly Commission Exp. March 11, 2012 <br />ao �` �s Commission # DD 756663, <br />>� �a SIGN: <br />4 U <br />PRINT: l c" �t Cr l %L %� <br />Notary Public, State at fQe <br />My Commission Expires: <br />(Seal) <br />00452-2 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1024-17thStreet and IR Blvd Intersection\Admim\Contract Documents\00452 Disclosure of <br />Ralatinnchinc rinr <br />