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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 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 />Signature: ZAut, <br />d /� — <br />Sheryl Ka s, Authorized Signatory <br />(Applicant) Beach Club Acquisition, LLC <br />Sworn to and subscribed before me, <br />This day of t4Lu 20 ag <br />Notary a blic, State of Florida at Lar Notary Public State of Florida <br />Large Blana J Cesar <br />1111 <br />My4Ho1c80754fon <br />Exp- 9/3012025 <br />My Commission Expires: spas <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 30 <br />53 <br />