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6 . Based on information and belief, the statement, which I have narked below , is true in relation <br /> to the entity submitting this sworn statement . [Please indicate which statement applies . ] <br /> XX Neither the entity submitting this sworn statement, nor any officers , directors , executives , <br /> partners , shareholders, employees , members , or agents who are active in management of the <br /> entity, have any relationships as defined in section 105 . 08 , Indian River County Code, with <br /> any County Commissioner or County employee . <br /> The entity submitting this sworn statement, or one or more of the officers , directors , <br /> executives, partners , shareholders , employees , members, or agents , who are active in <br /> management of the entity have the following relationships with a County Commissioner or <br /> County employee : <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> (Signature) <br /> 9 / 23 / 03 <br /> (Date) <br /> STATE OF FLORIDA <br /> COUNTY OF BROWARD <br /> The foregoing instrument was acknowledged before me this 2 3 day of SEPT * 20 0 3 , by <br /> FRANK 0 MONTI JR , who is personally known to me or who has produced <br /> as identification . <br /> NOTARY,/ PUBLIC11 <br /> a DATA SIGN : ���1_G,. � 1�� Z �t lC <br /> r J1 # DD 019012 <br /> rx _ rpril 19. 2005 BRIDGIT A PATAK <br /> 9�-nd �9. � PRINT : <br /> State of Florida at Large <br /> My Commission Expires : <br /> (Seal) <br /> Page 41 of 56 <br />