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b Based on information and ;behef,;theisiatement which T,have marked&below,is-true�in'frelation;to <br />theenttty siilimitttng#this sworn statement. (please`indicate wtiicti sfatementappties] <br />Nither the entitysubmittingathis sworn statement, nor any oliicers,directors,ezecut s; <br />partners; 'fir olds employees, members, �_or agents who pare � ctive sin <br />management of the'entity, Have any relattonshjps 0defined` n Section.lOS:OS Indian <br />River Gounty`66 with any County Commissioner or:County employee �y <br />The entity submitting this sworn, statement, or. one or more of the-oflicers directors;_ <br />executt es, partners, shareholders employees;members, or, agents=who Are vc in <br />Canny ;ment°of.the entity have the"following relaEionships with a Coun'tytCommtsstoner,or. <br />Cana e <br />employee; <br />=Name'of AffiliateName of County Commissioner Relationship or Entity or employee <br />i a <br />[signature <br />7/17/96 <br />[date] <br />`STATE OF . Flra <br />'COU NIYOF, Martin <br />The'foregomg ►nstmens was acknowledge&before me <br />this day of 9.J <br />qv1, 1:.tiy��t;�Oh(:.K;l;,sl�, , whois:.personallyknownto�me` <br />��ii.. <br />or who has"produced as identiflution: <br />NOTA y pUBLIC. <br />signer-`c�+,�v� <br />print tri i Gm�i I elWA <br />eStateof Flordalat large <br />MyW:ommission, xpires <br />i (Seal) <br />n ` r ry 'ATNICtA ROBINSON � <br />�� `S r�P,.. iA Coebn OCy99�12 <br />zee t <br />S <br />Mg.l <br />c Ss r m <br />