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6 . Based on information and belief, the statement which I have marked below is true in <br /> relation to the entity submitting this sworn statement . [please indicate which statement <br /> applies . ] <br /> Neither the entity submitting this sworn statement, nor any officers , directors , <br /> executives, partners, shareholders , employees , members, or agents who are active in <br /> management of the entity, have any relationships as defined in Section 105 . 08 , Indian <br /> River County Code , with 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 <br /> in management of the entity have the following relationships with a County <br /> Commissioner or County employee : <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or Entity or employee <br /> � ,,�•%D....�, kms, ��� "'`� <br /> [signature] <br /> ?, 3 - 2 - -:, 3 <br /> [date] <br /> STATE OF rjo/idA <br /> COUNTY OF &?04 fot <br /> The foregoing instrument was acknowledged before me this day of J <br /> 20 D3 , by b LdtAm b . Sir ' z4off.ca- Mmqr � , <br /> of sicon011 IdfA j ?CCA . a Z (44d4e &- corporation, on <br /> behalf of the corporation . He/She is personally known to me or who has produced <br /> as identification. <br /> NOTARY PUBLIC <br /> sign : a� <br /> print : �o►. xi pati Scavone <br /> • My Commission DD152605 <br /> o, M1 Expires September 23, 2006 <br /> State of Florida at large <br /> My Commission Expires : <br /> ( Seal) <br />