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NAME. ADDRESS AND OFFICE (if applicable) Percentage of Interest <br />Date of <br />If any contingency clause or contract terms invo additional parties, list all individuals or officers, <br />if a corporation, partnership or trust. <br />For changes of ownership or changes in contracts for purchase subsequent to the date of the <br />a ication, but prior to the date of final public hearing, a supplemental disclosure of interest shall <br />be filed. <br />......................................................................................................................... <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: fl�4 <br />(Applicant) Eric Fordin, AuftrLed Represente:ive for MB RE Investments, LLC <br />Sworn to and subscribed before me, <br />This l f, day of t ,! ,.s , 20 '3 L4 <br />` ```�^ 4pe.n- <br />•., BETSYCOURSHON <br />Notary Public, tate of Florida at Large `:«= MYCOMMISSION � HH 32IM3 <br />EXPIRE$. November $ 2026 <br />My Commission Expires- <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 N <br />City of Sunny Isles Beach <br />Public Hearing Application Package <br />Page 16 of 23 <br />74 <br />