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SWORN STATEMENT UNDER SECTION 105. 08, <br /> INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS <br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR <br /> OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement is submitted with RFP No. 2006061 for _H . O . P. E . Academy <br /> 2. This sworn statement is submitted by: -Project H . O . P. E. <br /> Henry Burson , Jr. = <br /> ( Name of entity su mittin Statement) <br /> whose business address is : <br /> 4875 43" Avenue , Vero Beach , FL 32967 and <br /> (if applicable ) <br /> its Federal Employer Identification Number (FEIN) is_59-3739693 <br /> ( If the entity has no FEIN , include the Social Security Number of the individual signing <br /> this sworn statement <br /> 3. My name is Henry Burson , Jr. <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above is _Chairman of Board <br /> 4. I understand that an "affiliate' as defined in Section 105. 08 , Indian River County <br /> Code, means : <br /> The term "affiliate" includes those officers, directors , executives, partners, shareholders, <br /> employees, members , and agents who are active in the management of the entity. <br /> 5. 1 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 in <br /> relation to the entity submitting this sworn statement. [Please indicate which statement <br /> applies .] <br /> XIII <br />