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e <br />4W <br />• <br />or I a .. 1 0 <br />ris sworn statement. (please indicate which statement <br />4 plies). r. <br />AXX-- Neither the entity submitting this sworn statement# nor any <br />bf€kers, directors, executives, partners, shareholder's, <br />en0oyees, members, or agents who are active in management <br />of the entity, have any relationships as defined in Section <br />105.08, Indian River County Code, with any County <br />Commissioner or County employee. <br />The entity submitting this sworn statement, or one or more <br />of the officers, directors, executives, partners, <br />shareholders, employees, members, or agents who are active <br />in management of the entity have the following relationships <br />with a County Commissioner or County employee. <br />Name of Affiliate Dame of County Relationship <br />Or Entity Commissioners <br />NONE <br />(Signmture) <br />February 17, 2000 <br />(Date) <br />STATZ OF Florida <br />COUN'T'Y OF Polk <br />Tho foregoing instrument was acknowledged before me this 17th day <br />of February , x 20POby .Tames H. Chambers —, who its <br />poraonally known #o me or who has produced <br />—as i.demtification. <br />0TAltx PUBLIC <br />sIGNp,TURE <br />PRINT <br />OP FWAMARM-1VAGE <br />i k0111V Pubda, SttS@ of F1add4 <br />My eamm. axorm gin. 9. M2 <br />Vftr . No, CCOTU25 <br />i <br />L. <br />L <br />EN0 OF SECTION <br />00310- �),'7 <br />