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The Plan Sponsor represents and warrants they are an employer eligible to adopt a governmental plan as <br />defined by Section 457(e)(1)(A) of the Internal Revenue Code of 1986, as amended (check one below): <br />_(A) State of (including Commonwealth) <br />— (B) political subdivision of the State or Commonwealth of <br />— agency of (A) or (B): <br />— instrumentality of (A) or (B): <br />Nationwide Retirement Solutions, Inc. Indian River County <br />Plan Sponsor <br />By: — <br />Name: <br />Title: <br />Date: <br />By: — <br />Name: <br />Title: <br />Date: <br />-14- <br />P171 <br />