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n <br />(signature) <br />(date) <br />STATE OF l.04A <br />COUNTY OF 1111 Tt <br />0 <br />Personally appeared before me, the undersigned authority, T)1 Vi(Z IL. L'" fis <br />who after first being sworn by me, affixed his/her signature in the space provided above on this <br />(4- day of l' F.MaeiL , 20 2. <br />4 �611649FF98-0153 <br />6B� ELYZZAH R HEFFERNAN <br />otaryic, State arge My coMMlssfoN # DD4If ls7 <br />My Commission Expi es: 3J40 ,OQ� EXPIRES: Mar.24,2009 <br />Florida Notary Seroce.com <br />* * END OF SECTION * * <br />00452,2 <br />PAPuhflc Works\Capital Projects\Oslo Road Lateral J\BIO DOCUMENTS\00452 • Disclosure of Relationships.doc Rev. 05/01 <br />00452 - Disclosure of Relationships <br />Name of Affiliate <br />or Entity <br />Name of County <br />Commissioner or employee <br />Relationship <br />1. <br />2. <br />3. <br />4, <br />5. <br />6. <br />7. <br />8. <br />(signature) <br />(date) <br />STATE OF l.04A <br />COUNTY OF 1111 Tt <br />0 <br />Personally appeared before me, the undersigned authority, T)1 Vi(Z IL. L'" fis <br />who after first being sworn by me, affixed his/her signature in the space provided above on this <br />(4- day of l' F.MaeiL , 20 2. <br />4 �611649FF98-0153 <br />6B� ELYZZAH R HEFFERNAN <br />otaryic, State arge My coMMlssfoN # DD4If ls7 <br />My Commission Expi es: 3J40 ,OQ� EXPIRES: Mar.24,2009 <br />Florida Notary Seroce.com <br />* * END OF SECTION * * <br />00452,2 <br />PAPuhflc Works\Capital Projects\Oslo Road Lateral J\BIO DOCUMENTS\00452 • Disclosure of Relationships.doc Rev. 05/01 <br />00452 - Disclosure of Relationships <br />