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50 1 understand that the relationship with a County Commissioner or County
<br /> employee that must be disclosed as follows:
<br /> Father, mother, son , daughter, brother, sister, uncle, aunt, first cousin ,
<br /> nephew, niece, husband , wife , father-in-law, mother-in-law, daughter-
<br /> in4aw, son4n-law, brother-in-law, sister-in-law, stepfather, stepmother,
<br /> stepson ,, stepdaughter, stepbrother, stepsister, half brother, half sister,
<br /> grandparent, or grandchild .
<br /> 6 . Based on information and belief, the statement, which I have marked below is
<br /> true in relation to the entity submitting this sworn statement. [Please indicate
<br /> which statement applies . ]
<br /> X Neither the entity submitting this sworn statement, nor any officers ,
<br /> directors , executives , partners , shareholders , employees , members , or
<br /> agents who are active in management of the entity, have any relationships
<br /> as defined in section 105 . 08 , Indian River County Code , with any County
<br /> Commissioner or County employee .
<br /> The entity submitting this sworn statement, or one or more of the officers ,
<br /> directors , executives , partners , shareholders , employees , members , or
<br /> agents , who are active in management of the entity have the following
<br /> relationships with a County Commissioner or County employee:
<br /> Name of Affiliate Name of County Commissioner Relationship
<br /> or enti or employee
<br /> (signature)
<br /> 5 -2S- d %4
<br /> (date) f
<br /> STATE OF GNU COUNTY OF
<br /> The foregoing instrumentMas ack owledge eforg -me this c ZS day of
<br /> 2004 , by aD ho is p onally
<br /> known me or who has produced r 0zom as
<br /> identification . NOTARY PUgklC ,
<br /> SIGN : t
<br /> PRINT:
<br /> State of Florida at Lq!o
<br /> My Commission Expires :
<br /> (Seal) � T A°BGc TRACY L SLAUGHTER
<br /> � N(YCOMMISSION #' DD025716
<br /> �?'OFF��
<br /> Service 8 Borang, ik
<br /> 'l
<br /> jij,
<br /> r
<br />
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