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6 . Based on information and belief, the statement, which I have marked below, is true in relation <br /> to the entity submitting this swom statement . [Please indicate which statement applies . ] <br /> 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 /> ( a ure) <br /> b <br /> STATE OF (Date) <br /> COUNTY OF <br /> Thf regomg instrument was a owledged before me this day of1k1A& "dA' y <br /> 0wh is personally known to me or who has produced <br /> identification. <br /> NOTARY PUBLIC <br /> r <br /> SIGN : <br /> PRINT : tom' <br /> State of Florida at Large <br /> GWVAM NW My Commission Expires : <br /> W 0004919 (Seal) <br /> t 1 Msen�r �,p� <br /> 6706-38666\2/5/04 Page 44 of 59 VRB <br />