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OWNERSHIP AFFIDAVIT <br />FOR LIMITED LIABILITY COMPANY <br />STATE OF Public Hearing No. <br />COUNTY OF Mtgkoyt <br />Before me, the undersigned authority, personally appeared 70rA INS" t t <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 �"�~1�A0�Kst-'�(► i..1--�• <br />_ _Limited Liability Company with the following <br />address: ' <br />P�c�kt. t� �l'p�w� KIA 0+qe>1 <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 />L--'RA-1q NLUOS AQe ton kn 0AA` I- 40-a. <br />UnAiv Icl b27A, Ya 14 irr G&ALD6 eIemtMs p��g-a4, 14 02948 <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 per Wyxand.the___... <br />possibility of voiding of any zoning granted at public hearing. <br />6. Affiant understands that the matters attached to and mads part of the application are <br />honest and true to the best of my knowledge and bplieE I understand this application must <br />be complete and accurate before the application -can be submitted and the hearing <br />advertized. <br />Wi s: <br />:• <br />Si a Affianfs-Signature •... e <br />Print Name Print Name <br />Signature <br />Print Name q <br />ty <br />Sworn to and subscribed before me on theiA da <br />Affiant is personally Imown to me or has prouced <br />Identification. <br />Commission Expires: <br />BERNADETTE KOPEC <br />ID #2433023 <br />NOTARY PUBLIC <br />STATE OF NEW JERSEY <br />My Commission 9xpires April 23, 2028 <br />Page 10 of 23 <br />32 <br />