Laserfiche WebLink
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 yin 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 />� 0 C'ORPO� <br />0 ni <br />••• 7994 •• <br />04/11 <br />(Date) <br />ORID + <br />STATE OF FLORIDA �,,,rrrirrt�,,,+ <br />MARTIN <br />COUNTY OF <br />The foregoing instrument was acknowledged before me this 11TH day of ARPIL 120 <br />181 by <br />MYRA SMITH <br />who is personally known to me or who has produced <br />as identification. <br />o�pRY Pt/p�� WANDA SUE SMART <br />MY COMMISSION If FF 097934 <br />EXPIRES: April 25,2018 <br />r�FOFF,oe�O BondedtAruBudget Notary Services <br />NOTARY PUBLIC <br />SIGN: WaInda .u— <br />WANDA SUE SMART <br />PRINT: <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) <br />00452-2 <br />F:\Public WorksAENGINEERING DIVISION PROJECTS\1745 (CR510) 85th Street Right Turn Lane Extension at 66th Ave\i Admin\Bid <br />'Documents\Master Contract Documents\00452 Disclosure of Relationships.doc <br />i <br />