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<br />~ <br /> <br />SECTION 21 <br />ANTI.KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br /> <br />COUNTY OF <br /> <br />A~FIX ~OTARY STAMP HERE: <br /> <br />. ~ 'l'~ <br /> <br />o <br /> <br />,:' ';~'~UC:= STA1I:AllARGE <br />N: CeMMiSSION EXPIRES 03-29-2010 <br /> <br />" <br /> <br /> <br />~S~naIlY Known <br />[] Produced Identification <br /> <br />OR <br />Type of Identification Produced <br /> <br />END OF SECTION <br /> <br />o <br /> <br />78 <br />