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Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> Phil Barth Sandy Wright Cousin <br /> (Signature ) <br /> ID 2� <br /> STATE OF Florida ( Date ) <br /> COUNTY OF Indian River <br /> The foregoing instrument was acknowledged before me thiAay. f , 2004 by <br /> L. '23 / who is rsonally known to me or who <br /> has produced as <br /> identification . <br /> NOTARY PUBLIC <br /> SIGNJa� � <br /> PRINT : � 1-IC <br /> State of Florida at Large <br /> My Commission Expires : ,7 /` gr <br /> (Seal ) <br /> e Ps. <br /> Marion H Tupbk <br /> F <br /> • My Commi6WW DD330M <br /> iia ; dO Exprw Juy 21 , 2008 <br /> 2 <br />