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Bid No. 2019016/IRC-1631 <br />Under penalty of perjury, Permittee declares that it has read the foregoing affidavit and the facts <br />stated in it are true. <br />Permittee: <br />Authorized Signature: <br />Printed Name: <br />Date: <br />Work Telephone: <br />Mobile Telephone: <br />Email Address: <br />FURTHER AFFIANT SAYETH NAUGHT <br />(If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br />********************************* <br />The foregoing instrument was subscribed and sworn to before me this day of <br />, 20_ by <br />who is personally known to me or has produced <br />identification and who did take oath. <br />My Commission expires: <br />as <br />Notary Public State of Florida at Large <br />Page 45 of 45 <br />