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the entity.
<br />i. I understand that the relationship with a County Commissioner or County employee
<br />that must be disclosed as follows:
<br />Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin,
<br />nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-
<br />in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
<br />stepson, stepdaughter, stepbrother, stepsister, half brother, half sister,
<br />grandparent, or grandchild.
<br />6. Based on information and belief, the statement which I have marked below is true
<br />in relation to the entity submitting this sworn statement. [Please indicate which
<br />statement applies.]
<br />_jX_ Neither the entity submitting this sworn statement, nor any officers, directors,
<br />executives, partners, shareholders, employees, members, or agents who are
<br />active in management of the entity, have any relationships as defined in
<br />section 105.08, Indian River County Code, with any County Conurissioner or
<br />County employee.
<br />The entity submitting this sworn statement, or one or more of the officers,
<br />directors, executives, partners, shareholders, employees, members, or agents,
<br />who are active in management of the entity have the following relationships
<br />with a County Commissioner or County employee:
<br />Name of Affiliate Name of County Commissioner Relationship
<br />5 or entity or employee
<br />(s gn
<br />(date)
<br />13
<br />
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