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Neither the entity submitting this sworn statement, nor any officers, directors, executives, <br />parmers, shareholders, employees, members, or agents who are active in management of <br />the entity, have any relationships as defined in Section 105.08, Indian River County <br />Code, with any County Commissioners or County employee. <br />_ The entity submitting this sworn statement, or one or more of the afters, directors, <br />executives, partners, shareholders, employees, members or agents who are active in <br />management of the entity have the following relationships with a County Commissioner <br />or County employee. <br />Name ofAffiliate NamcofCtNntv Relaiomiln <br />Or Entit Commissione <br />(Signature) <br />11/29/00 <br />(Dale) <br />State of PI iy r . <br />County of Palk <br />The foregoing instrument was acknowledged before me this 29d8y of Nov -tuber 2000, by <br />_J—u T. Chaaaem_u aaei—= Ch—h i—, who is personally known to me or has produced <br />as identification. <br />O 11,` -gP1{1R ICc <br />Sign re <br />PRINT' <br />STTE OF FLORIDA AT LARGE <br />{\ ,J <br />MV cyco oYNELLa. sTWR yn onc. say. of Finaea <br />mnCOMO, V JaLnCu,20*2 <br />RB25 <br />END OF SECTION <br />00310-12 <br />