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NAME. ADDRESS AND OFFICE (if applicable) Percentage of Interest <br />Date of Contract: <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 heating, a supplemental disclosure of interest shall <br />be tiled. <br />...................................................................................................................... <br />The above is a full disclosure of all parties of interest i e applic ti n to th of my knowledge <br />and belief. <br />Signature. <br />(Applicant) U"ardgo r c..cQ gttk eJ( � <br />Sworn to and subscribed before me, <br />This _day of YilVve%*4lr- , 20 7-1 <br />F. <br />x' Fug . MARITZA GONZA! EZ•ORTIZ <br />? :',� Notary Public - State of Florida <br />Notary Public, State -of Florida at Large Y` l»� Commission GG 327338 <br />dF F ° ` My Comm. Expires Aug 15, 2023 <br />Bonded through National Notary Assn. <br />�r.,�am�e�ar�mt: <br />My Commission Expires: 23. <br />* Disclosure shall not be required of any entity; the equity interest is which are regularly traded on <br />an established securities market in the United States or other country; or any entity, the ownership <br />interest of which are held in a limited partnership consisting of more than 5,000 separate interest <br />and where no one person or entity holds more than a total of 5% of the ownership interest in the <br />limited partnership. <br />Public Hearing No: <br />City of Sunny Isles Beach Public Hearing Application Package Page 16 of 23 47 <br />