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NAME, ADDRESS AND OFFICE (if applicable) Percentage of Interest <br />Date of Conti -act: <br />If any contingency clause or contract terms involve additional parties, list all individuals or officers, <br />if a corporation, partnership or trust. <br />For any changes of ownership or changes in contracts for purchase subsequent to the date of the <br />application, but prior to the date of final public hearing, a supplemental disclosure of interest shall <br />be filed. <br />The above is a full disclosure of all parties of interest in the application to the best of my knowledge <br />and belief. <br />Sworn to and subscribed before me, <br />of <br />Notary Pyblic, <br />My <br />* Disclosure shall <br />an established sec ritirr <br />interest of which a held in a <br />and where no one person or ei <br />limited partnership. <br />Public Hearing No: <br />(Applicant) at-tfilln OKI+ <br />20 A <br />Jackson Wong Jackson Wong Public Notary Public <br />-Nffla—rY <br />. Niqw . hweni— New Jersey <br />the <br />of the ownership interest in the <br />City of Sunny Isles Beach Public Hearing Application Package Page 16 of 23 <br />