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Cultural Council of Indian River County; After Schcol Arts Program
<br /> Children' s Services Advisory Committee 2004
<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 is submitted with RFP No . 6067 for
<br /> After School Arts Program
<br /> 2 . This sworn statement is submitted by :
<br /> Cultural Council of Indian River Courrtiy
<br /> Whose business address is :
<br /> 214514 th Ave . , Suite 11 , Vero Beach , Florida 32960 and
<br /> its Federal Employer Identification Number ( FEIN ) is
<br /> 59 -3299133
<br /> 3 . My name is
<br /> Mary Jayne Kelly
<br /> and my relationship to the entity named above is
<br /> Executive Director ,
<br /> 4 . 1 understand that an " affiliate" as defined in Section 105 . 08 , Indian River
<br /> County Code , means :
<br /> The term " affiliate" includes those officers , directors , executives , partners ,
<br /> shareholders , employees , members , and agents who are active in the
<br /> management of the entity.
<br /> 5 . 1 understand that the relationship with a County Commissioner or County
<br /> employee 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 /> in4aw, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
<br /> stepson, stepdaughter, stepbrother, , stepsister, half brother, ., half sister,
<br /> grandparent ,, or . grandchild. 41
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