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Division 2 - Technical Provisions, IRC -1638 <br />Under penalty of perjury, PERMITTEE declares that it has read the foregoing affidavit and the facts <br />stated in it are true. <br />FURTHER AFFIANT SAYETH NAUGHT <br />Permittee: <br />Authorized Signature: <br />Printed Name: <br />Date: <br />Work Telephone: _ <br />Mobile Telephone: <br />Email Address: <br />STATE OF <br />COUNTY OF <br />(If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br />********************************* <br />Sworn to (or affirmed) and subscribed before me by means of ❑ physical presence or ❑ online <br />notarization, this day of 20 , by <br />(name of person 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 />++ END OF SECTION ++ <br />Division 2 - Technical Provisions - 01025-14 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1638 6th Avenue US -1 to 21st Street Resurfacing (SCOP)\1-Admin\Bids\Bid Documents\DIV 2_TECHNICAL PROVISIONS - <br />20201002.docx <br />