Laserfiche WebLink
entity, have any relationships as defined in section 105.08, Indian River County Code, with any <br />County Commissioner or County employee. <br />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 <br />entity have the following relationships with a County Commissioner or County employee: <br />Name of Affiliate <br />or entity <br />STATE OF <br />Name of County Commissioner <br />or employee <br />Relationship <br />w (Signature) <br />(Date) <br />COUNTY OF R_ <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 />SIGN: <br />PRINT: <br />NOTARY PUBLIC <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) <br />133 <br />