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AFFIDAVIT OF COMPLIANCE WITH FOREIGN ENTITY LAWS <br /> City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />The undersigned, on behalf of the entity listed below (“Entity”), hereby attests <br />under penalty of perjury as follows: <br />1.Entity is not owned by the government of a foreign country of concern, as <br />defined in Section 287.138, Florida Statutes. <br />2.The government of a foreign country of concern does not have a controlling <br />interest in Entity, as defined in Section 287.138, Florida Statutes. <br />3.Entity is not organized under the laws of a foreign country of concern, as defined <br />in Section 287.138, Florida Statutes. <br />4.Entity does not have a principal place of business in a foreign country of concern, <br />as defined in Section 287.138, Florida Statutes. <br />5.The undersigned is authorized to execute this affidavit on behalf of Entity. <br />Date: ____________________, 20___ Signed: <br />Entity: Name: <br />Title: <br />STATE OF <br />COUNTY OF <br />The foregoing instrument was acknowledged before me, by means of ☐ physical <br />presence or ☐ online notarization, this ____ day of ______________, 20____, by <br />_______________________________, as ____________________________ for <br />_____________________________________________________, who is personally <br />known to me or who has produced ________________________ as identification. <br />Notary Public Signature: State of Florida at Large (Seal) <br />Print Name: My commission expires: