Laserfiche WebLink
The entity submitting this sworn statement, or one or more of the officers, directors, <br /> executives, partners, shareholders, employees, members, or agents, who are active in <br /> management of the entity have the following relationships with a County Commissioner or <br /> County employee: <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> (Signature) <br /> (Date) <br /> STATE OF <br /> COUNTY OF <br /> The foregoing instrument was acknowledged before me this day of . 20 by_ <br /> who is personally known to me or who has produced <br /> as identification. <br /> NOTARY PUBLIC <br /> SIGN: <br /> PRINT: <br /> Notary Public, State at large <br /> My Commission Expires: <br /> (Seal) <br /> Page 11 of 11 <br />