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Signat re- Witness #1 <br />Printed Name - Witness #1 <br />53'7-r1-ruG <br />5ebcn h a r. , -Y L Sam <br />Addd,,reresss -- Witness #1 <br />/4G—_ <br />Sin ture fitness 2 <br />J. <br />Printed Name - Witness #2 <br />Address -Witness 2 <br />STATE OF FLORIDA <br />COUNTY OF <br />INDIAN RIVER COUNTY, <br />a political subdivisi the State of Florida <br />By: - AM <br />Sean LiAske <br />Director, De artm nt of Utility Services <br />Date: 11 a�2 <br />—T <br />The foregoing instrument was acknowledged before me, by means of El physical <br />presence or ❑ online notarization, this A6- day of 1: ✓e"I-eJ , 2024 by L- tsk. t - <br />the �) tir« h. o/ O4 ,'(,'f ; . tr✓,cr� of INDIAN RIVER COUNTY, a political <br />subdivision of the State of Florida, who is 13,15ersonally known or ❑ produced identification in the form <br />of <br />SEAL: <br />Approved as to form and <br />legal suffigiieracy: <br />By: <br />County Attorney <br />Initials 6It <br />i4lf44kb' <br />NOTARY PUBLIC: <br />Sign: �aL'a", / LA�:Y ci -cam- <br />Printed Name: -c, ice- Z-•l",rt a lc6l <br />Commission No.: <br />Commission Expiration: <br />��►' HEATHER L. ALEWN --R <br />Notary Public - State of : orice <br />Commission N HH 45397 <br />o. F My Comm. Expires Mar • 7, 2i 2 <br />Bonded through Nationai Nctarf ASST. ` <br />nupqwpq <br />License Agreement <br />8350 58TH AVE <br />Page 6 of 6 <br />