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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 /> 7. <br /> 8. <br /> z <br /> '.i <br /> ..signa Tarr-�j <br /> 0 - 7 - o <br /> 3 . <br /> (date) <br /> STATE OF / <br /> COUNTY OF <br /> Personally appeared before me , the undersigned authority, <br /> who after first being swom by me, affixed his/her signature in the space provided above on this <br /> day of /rl Ay , 20 03 . <br /> Notary Public, State at large <br /> -Aii � <br /> My Commission Expires : <br /> , WbINME as Co emission iR:771 <br /> ` END QF. SECTION <br /> '4 ExPifes 9i` „; vBonded th(so32.4" 40)4f <br /> 00452 - Sworn Statement under Sed 105.08 Indian River County Code on Disclosure of Relationships <br /> 00452 - 2 <br /> FVub k WorksiKAMW&wm"ter R*&AmGffGrd &3ACanetrudton Cmft M"52 - Swom Statement under Sea Indlarr Rtver County Code Up <br /> Z <br /> on Oisdosura of R62ean$h1M doc Rev. 0=1 <br />