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r <br /> r , <br /> 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 /> 7 . <br /> 8 . <br /> (signature) <br /> ( date) <br /> STATE OF V%-0 e-\ 04N <br /> " COUNTY OF 5 <br /> Personally appeared before me , the undersigned authority, e3e dir & %A 4C <br /> who after first beingsworn by me , affixed his/her signature in the space provided above on this <br /> '2�0 day of Syt•, , 20 0 5 . <br /> 6 Dianne Lynn on'Beasley <br /> C� `--�----- • MY Commission DD281180 <br /> Wtor Public, State at large Expires oot W 23, 2007 <br /> My Commission Expires : Io \ To b � <br /> rr <br /> sir <br /> i <br /> i <br /> * * END OF SECTION <br /> t <br /> r. 0016-00452 - Disclosure of Relationships ; <br />