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Docusign Envelope ID: 9199AF63-50A4-442C-AE7A-7B4C4273688F <br />DISCLOSURE OG INTEREST <br />If the property which is the subject of the application is owned or leased by a CORPORATION, <br />list the principal stockholders and principal officers or stockholders consist of another corporation <br />(s), trustee (s), partnership (s) or other similar entities, further disclosures shall be required which <br />disclosures the identity of the individual (s) (natural persons having the ultimate ownership interest <br />in the aforementioned entity). <br />Corporation Name <br />Name Address and Office <br />Assinado'por: <br />FBIAOSC680DE475... <br />Percentage of Stock <br />If the property which is the subject of the application is owned or leased by a LIMITED <br />LIABILITY COMPANY list the members or stockholders consist of another corporation (s), <br />trustee (s), partnership (s) or other similar entities, further disclosures shall be required which <br />disclosures the identity of the individual (s) (natural persons having the ultimate ownership interest <br />in the aforementioned entity). <br />LLC Name <br />Name, Address and Office <br />City of Sunny Isles Beach <br />Public Hearing Application Package <br />Percentage of Stock <br />Page 14 of 23 <br />KYA <br />