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6 . Based on information and belief, the statement, which I have marked below, is true in relation to the <br /> entity submitting this sworn statement. [Please indicate which statement applies. ] <br /> 40001 Neither the entity submitting this sworn statement, nor any officers, directors , executives , partners, <br /> shareholders, employees, members, or agents who are active in management of the entity, have any <br /> relationships 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, directors, executives , <br /> partners, shareholders, employees, members, or agents, who are active in management of the entity <br /> have the following relationships with a County Commissioner or County employee : <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> jo <br /> ( Signature) <br /> C3 <br /> T ( ate) <br /> STATE OF T / � <br /> COUNTY OF <br /> The foregoing instrument was acknowledged before me this _ day of , 20.09 <br /> b � 14 .0 , who is personally known to me or who ias produced <br /> 5ridRr <, , Urn c'e as identification. <br /> RY P C <br /> SIG41 -- <br /> PRINT : cvi 5 <br /> Notary Public , State at large <br /> My Commission Expires: <br /> (Seal) <br /> IOANNIS MITSIS <br /> MY COMMISSION # DD 175094 <br /> EXPIRES: December 30, 2006 <br /> Eb 8WdedThruNoteryP <br /> rs <br /> Page 24 of 38 <br />