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r <br /> 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 's p�bmitted wtt1 RFP No. 2006061 for <br /> Ce..,S �' i U e, �W ll✓ �(( 1 <br /> - - U <br /> 2 . This sworn statement is submitted by: � � f- 0 vii Yom., <br /> ! (Name of entity submitting Statement) <br /> \i <br /> whose business address is : <br /> t� tlG �� C �C `D�/ /and <br /> (if applicable) <br /> its Federal Employer Identification Number FEIN is <br /> y ( FEIN ) �( If the the entity has no FEIN , include the Social Security Number of the individual signing <br /> this sworn statement <br /> ) <br /> 3 . My name is 1 A GAaL <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above is <br /> 4 . 1 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 />