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Neither the entity submitting this sworn statement, nor any officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in management of the <br />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 />COUNTY OF <br />Name of County Commissioner <br />or employee <br />Relationship <br />(Signature) <br />(Date) <br />Sworn to (or affirmed) and subscribed before me by means of ❑ physical presence or ❑ online <br />notarization, this day of 20 , by (name of person <br />making statement). <br />(Signature of Notary Public - State of Florida) <br />(Print, Type, or Stamp Commissioned Name of Notary Public) <br />❑ who is personally known to me or ❑ who has produced <br />as identification. <br />115 <br />