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Name of Affiliate Name of County Relationship <br /> or Entity Commissioner or employee <br /> 1 . <br /> 2 . <br /> 3. <br /> 4. <br /> 5. <br /> 6 . <br /> 6 . <br /> 8 . <br /> (signature) <br /> 9 -) <br /> J - (date) <br /> STATE OF <br /> COUNTYOF <br /> Personally appeared before me, the undersigned authority, l aom r Orn <br /> who after first bein swom by me, affixed his/her si nature in the space provided above on this <br /> _� day of �a p�m�^ , 20�. <br /> Notary Public, State at larg <br /> My Commission Expires : <br /> Alysa A . Comfort <br /> Commission # DD284684 <br /> "4, s' Expires May 26 , 2008 <br /> F O>= M1� t)W&d Troy F.n - Neoism, Inc. 800.185.7019 <br /> * * END OF SECTION <br /> 00452 - Disclosure of Relationships <br /> 00452 - 2 <br /> F9Public WorkslCepitxl Prcjeds1O510 RoactOslo Widening, Old Dive to 27th Ave\CONTRACT DOCUMEN N52 - Dlsdowre of Relatiomhips.doc Rev. 05N1 <br />