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A <br />OWNERSHIP AFFIDAVIT <br />FOR LIMITED LIABILITY COMPANY <br />STATE OF tSN Public Hearing No <br />COUNTY OF. tA-s t- ir i < � <br />Before me, the undersigned authority, personally appeared ai4A1W OA!sk <br />hereinafter the Affiant (s), who being first duly sworn by me, on oath, deposes and says: <br />Affiant is the manager, or managing member of the — 14 3 5 18, L L-r' <br />Limited Liability Company with the following <br />address: <br />2. The Limited Liability Company owns or lease (circle one) the property, which is the <br />subject of the proposed hearing, <br />3. The subject property is legally described as: <br />W nlLiq <br />'NaLt4s; kefl()e- <br />00410 <br />U10301 Irldiv 'l.'1�2.�9l�, <br />IMT Id <br />e"Onlynoti <br />-F!t664-'s <br />OFr Qbd, <br />Mlq-asYq <br />4. Affiant is legally authorized to file this application for public hearing: <br />S. Affiant understands this affidavit is subject to the penalties of law for perjury and the <br />possibility of voiding of any zoning granted at public hearing. <br />6. Affiant understands that the matters attached to and made part of the application are <br />honest and true to the best of my knowledge and belief. I understand this application must <br />be complete and accurate before the application can be submitted and the hearing <br />advertized. <br />Witnesses - <br />Affiant's Signature <br />6*01HA km5A <br />Print Name <br />rrint iName <br />Sworn to a cribod-Wore me on the 9 day of <br />Affiant is p=ua yEow) to me or has produced <br />Identification. <br />Jackson Wong <br />Commission Expims: Notary Public <br />New Jersey <br />My Commission Expires 4-10-2023 <br />No.2432483 <br />Page 10 of 23 <br />