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Witnesses: <br />Printed Name: <br />Printed Name: <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Developer: <br />Printed Name: <br />Title: <br />(If corporation, president, vice president, or secretary) <br />The foregoing was acknowledged before me this <br />200_, by as <br />day of , <br />for <br />Signature of Notary Public - State of Florida <br />Stamped Seal with printed <br />Name and Commission # <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />-19 <br />