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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 entity, <br />have the following relationships with a County Commissioner or County employee: <br />Name of Affiliate <br />or entity <br />Name of County Commissioner <br />or Employee <br />Relationship <br />8. Based on information and belief, the Disclosure of Financial Conflict of Interest statement, which I have <br />marked below, is true in relation to the entity submitting this sworn statement. [Please indicate which <br />statement applies.] <br />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 entity, have <br />an financial or business relationships as defined under item number 6 above, with any County <br />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 entity, has <br />the followinu financial or business relationships with a County Commissioner or County employee: <br />Name of Affiliate or Entity <br />Name of County Commissioner <br />or Employee <br />Description of Business or Financial <br />Relationship <br />-91-14(Signature) <br />(Date) <br />ATTACHMEN�6� <br />Local Jobs Grant Applicant Sworn Statement on Disclosure of Relationships Page 2 of 3 <br />