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OWNERSHIP AFFIDAVIT <br />FOR LIMITED LIABILITY COMPANY <br />STATE OF Public Hearing No. <br />COUNTY OF <br />Before me, the undersigned authority, personally appeared Shlomo Melloul <br />hereinafter the Affiant (s), who being first duly sworn by me, on oath, deposes and says: <br />1. Affiant is the manager, or managing member of the <br />19020 NBR LLC <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 />19020 North Bay Rd, Sunny Isles Beach, FL, 33160 <br />4. Affiant is legally authorized to file this application for public hearing: <br />5. 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. l understand this application must <br />be complete and accurate before the application can be submitted and the hearing <br />advertized. <br />Witnesses: <br />hat re V Affiant's Signator <br />V/ K J fl l Jkfa/ice � I �L ta, <br />WNWe Print Name <br />Print Name ' <br />Sworn to and subscribed before me on the dl _day of `� , 20iL-:P , <br />Affiant is personally down to me or has produced as <br />Identification. <br />Commission Expires: <br />City of Sunny Isles Beach <br />Public Hearing Application Package <br />VILMA CECIOTAITE <br />Notary Public •State of Florida <br />Commission # HH 267874 <br />Ay Comm. Expires Sep 17, 2026 <br />d through National Notary Assn. <br />Page 10 of 30 <br />151 <br />