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=The entity submitting this sworn statement, or one or more of the officers, directors, executives, <br /> partners, shareholders, employees, members, or agents, who are active in management of the entity <br /> have the following relationships with a County Commissioner or County employee: <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> NONE <br /> • 1 (Signature)/ <br /> Q F- <br /> 'AL <br /> C 7 OCTOBER 8,2014 <br /> (Date) <br /> FLORIDAi" <br /> STATE OF <br /> COUNTY OF MARTIN <br /> The foregoing instrument was acknowledged before me this 8TH day of OCTOBER ZO 14 by <br /> DON R.MANCIL,JR. ,who is personally known to me or who has produced <br /> as identification. <br /> NOTARY PUBLIC <br /> eot�a�P:;e��c <br /> WANDA SUE SMART /LJ tOl C _ <br /> * * MY COMMISSION i FF 097934 SIGN: � _. <br /> N, or gnj9�'J. <br /> EXPIRES:April 25,2018 WANDA SUE SMART <br /> gr,O.",3-e BondedThru Budget Notary Services <br /> PRINT: <br /> Notary Public, State at large <br /> -'My Commission Expires: 04/25/2018 <br /> (Seal) <br /> 00452-2 <br /> F:\Public Works\ENGINEERING DIVISION PROJECTS\1219-Roseland Lake Improvements\Admim\Master Contract Documents\00452 Disclosure of <br /> Relationships.doc <br />