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STATE OF Florida <br />COUNTY OF -Miami -Dade <br />OWNERSHIP AFFIDAVIT <br />FOR LIMITED LIABILITY COMPANY <br />Public Hearing No. <br />,IT, OF <br />\SLESe <br />Bw <br />RECEIVED <br />PZ2025-03 <br />12/16/2024 <br />PLANNING & ZONING DEPT. <br />Before me, the undersigned authority, personally appeared Oren Shmueli I <br />hereinafter the Affiant (s), who being first duly sworn by me, on oath, deposes and says: <br />1. Affiant is the fflffliagff, 6F fflaRagiRg momber.f th SVP and CFO of <br />A3 Atlantic Boulevard, LLC, a Delaware Limited Liability Company with the following <br />address: <br />17780 Collins Avenue, Second Floor, Sunny Isles Beach, FL 33160 <br />2. The Limited Liability Company owns r lease (circle one) the property, which is the <br />subject of the proposed hearing. <br />3. The subject property is legally described as: <br />See Attached. <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. I understand this application must <br />be complete and accurate before the application can be submitted and the hearing <br />advertized. <br />Witnesses: <br />S gnatur Affiant'p-§rgnature <br />�V_•1 41 ANn-Q-) Oicv\ ``1Imine_I`, <br />PSint Name Print Name <br />Signature <br />C <br />us Ii -c tt-er� <br />Print Name <br />Sworn to and subscribed before me on the 13 day of D.C,Q VV11ae , 20 24 , <br />Affiant is personally known to me or has produced as <br />Identification. A n <br />�N tary (Stamp/Soal) ' <br />Commission Expires: 01 -7r,��ttttllllfff���/ <br />'\ " IVA GOP0y'SON <br />i//,i <br />h w. <br />•Z <br />#iH 154665 <br />Page 10 of 23 <br />14 <br />