Laserfiche WebLink
40 <br />-6. Based on information and belief, the statement which I <br />have marked 'below is true in relation to the entity <br />submitting this sworn statement. [please indicate which <br />rsta meat applies.] <br />Neither the entity submitting this sworn statement, nor <br />any officers, directors, executives, partners, <br />shareholders, employees, members, or agents who are <br />active in management of the entity, have any <br />relationships as defined in Section 105.08, Indian River <br />County Code, with any County Commissioner or County <br />employee. <br />The entity submitting this sworn statement, or one or <br />more of the officers, directors, executives, partners, <br />shareholders, employees, members, or agents who are <br />active in management of the entity have the following <br />relationships with a County Commissioner or County <br />employee: <br />Name of A f to ti me of Cou t Commassio er Relatio ship <br />2 __L n em to ee <br />(signature) <br />date <br />STATE of <br />cavrrrx oF_�� . <br />The foregoing instrument was acknowledged before me <br />this ��,} 19 key , <br />who. is sone own me or who has produced <br />cation. <br />HOTAp.Y8L <br />sign; <br />+Arr'"iiSy : Arlene Cole print: <br />MY COMMISSION,CCIS7289 EXPIRES ae 4X Florida <br />ca arge <br />September], 2OU2 M Commission Expires: <br />BONOEDiHRU TROY,A441NSVRAKEIMc y <br />(Steal) <br />