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C'rj\: L3CT 4F INTEREST <br />:r31z� SMS <br />� <br />ZM".ftff <br />FnsZI Ma <br />�MSW-.w"aa,3q r <br />CW W� ��MS ST/STEWO <br />,rte• -.t„ l ---w -. f A -t :",r-- jr!-=7, tae', am=-Vz- or ace -C <br />of <br />dik, r T and pF-a►c ►al Mince <br />ad fw t�w ezy of srmr I,,a sear',, 3d N,. 2 2 - 03 - 01 <br />�r o €rs • 1 + � �. 2 � r- E r.��rke r f z r,- nas rude Meerd <br />> X/ 7r /_ 7ssr*• ' . d r ' aY ---s - *A.i Ar daA based upm !Fi a own krowhedge <br />' i 'r z{ %PO tr* S rj - `r else abryow fad i% - z gibmaned Arid that the above r&w. <br />xr... � .�. , r• r � z•p � �s-r.• �" �� rxrrt� :J�s�rn = .. _.- __ p►o+�- <br />r• 9•y •.Y s•.�, %•I. �N <br />rev oe rra°rt1,d erlusy !.£. i'.. -'es:6V ed into any `greer em <br />�4"" ' -^> ; a•�!`I��j',� J',: 1.. 'Y 'T'�+g���'IiE taken "acte,, .y3�_� f�TE,.e,,Wy� �lrt1��WL pnlgG,l�'1yg,. p'1�CO•rM♦�1e�'QlOi1 <br />/r ..: • ri r' `-•�� �siR' A R`J• �w �• P/'.�X I lilt .•. �'•�-t• .. •y_,••IrNi.S V*.dzsum kon o prkkg iYY unW the <br />fr r, .w 's it : ' :ehary a�Fd eaoe�3Xr Oct for tNS proom <br />",m "a-' r•.� �"'r`r C•rpY ei aff+frx'ye'i, ntX anyprle a"i!€oCJQ-!� rvlth f#'1ClTf, is presl!r1t3y Suspended or CI{flCllMlif <br /><� y r t•!° (ior'rJsd i,r€ ja 1:DnWo byl"moi, State, (w Fec*W Agency, <br />s 1W*r. 1, r `•r --f, w its af%%o, not w y'-ww rploom end wA,h tt*m have any potential canfl€if of <br />a Ir y *ww ;- 0• 1 '11 • s r �Jofit„ cf ntradt, of poop" w4wetts for th s protect. <br />7 f tarnov •° -e W,, rr OO s+'Inat /s vwrr_rship"nwkVM lerlt is pfesently applying for any employee <br />V/,'Aft sar 101 �d fXr`.+Wn WY!h tip.; City of 5 n ny lines SCA& <br />S. I OwVy 1, 9° r , r•°rl°AA+ of tk* KWAVrs oF�°rrsrsV or ffwLWAwwM, Or staff has a vestrd interest in any <br />y <br />If 04 €NW -4 :' s' .i 11,00t Q( AM*fre r} 1! witifi6d In tflt p owel +on of sefvices, I, on behalf of the above <br />s;&r;4 WAAr, ,w,a rr Wgf #W tit/ of Surma h Iel bcath, <br />fhK . dsrlf Go � 'f,R' , • IOL -11 <br />br)m rn Type Wanir 4n4 Title <br />i� <br />Wxfp 0,0,64,4 WAe.CrdOuf Wom frig tf€ J l ias r i 0 ZZ <br />VrryM€�E�1 yiN/N11, (�j 1 <br />�,j Yr•/f€M�� l�f•°ln,fv.,,+Kpi fy� 111 rrrlillr,lt€+,i] [s �' ; � I i ! Jai " "': "C t= 1 <br />N(11"Y 04J$IX STATL OF FWRIDA <br />EM <br />!{f p0�fgr�j#ll F1r f wia ja� oval to if m 11, 7014 <br />