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SWORN STATEMENT UNDER SECTION 105 .08 , INDIAN RIVER COUNTY <br /> CODE , ON DISCLOSURE OF RELATIONSHIPS <br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER <br /> OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement is submitted with Bid, Proposal or Contract No . I RC 605 2. for <br /> _&Aotity2we 4 905H,&4 969 yci4ij6 eAmxNL (fhrX�iPiyls PRO ?Et.T <br /> 2 . This sworn statement is submitted by: /VM/1E [�N7� <br /> (Name of entity submitting Statement) <br /> whose business address is : <br /> 5r 91 eeC, ST Morro <br /> MMO , PL 32967 and <br /> (if applicable) its Federal Employer Identification Number (FEIN) is 65S , 0 ?41%6 D (If <br /> the entity has no FEIN , include the Social Security Number of the individual signing this <br /> sworn statement ) <br /> 3 . My name is _ 97L�1/6J L. e py ft�f <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above is pgdAllp6ur <br /> 4 . I understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code, <br /> means : <br /> The term "affiliate" includes those officers, directors, executives , partners , shareholders, <br /> employees , members , and agents who are active in the management of the entity. <br /> 5 . I understand that the relationship with a County Commissioner or County employee that must <br /> be disclosed as follows : <br /> Father, mother, son, daughter, brother, sister, uncle , aunt, first cousin, nephew, niece , <br /> husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in- law, <br /> sister- in- law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half <br /> brother, half sister, grandparent, or grandchild. <br /> 6706-3866612/5/04 Page 43 of 59 VRB <br />