Form OGC-CM 08 Page of Last revised September 11, 2003 DISCLOSURE STATEMENT State of Florida, Department of Education Contract No. Name of Contractor Signature (If Corporation, Partnership or D/B/A): Title Address Phone/ Fax Sworn to and subscribed before me this ____ day of ______________, ____, by ____________________________________________, who is personally known to me or who produced _______________________________ for identification. __________________________________________ Signature of Notary Public __________________________________________ Name of Notary Public My Commission expires: Form OGC-CM 08 Page of Last revised September 11, 2003
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