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NAIvfE,ADDRESS AND OFFICE(if applicable) Percentage of Interest <br /> Date of Contract: <br /> If any contingency clause or contract terms involve additional parties, list all individuals or <br /> officers,if a corporation,partnership or trust. <br /> For any changes of ownership or changes in contracts for purchase subsequent to the date of the <br /> application,but prior to the date of final public hearing, a supplemental disclosure of interest shall <br /> be filed. <br /> The above is a full disclosure of all parties of interest in the application to the best of my <br /> knowledge and belief. ' <br /> •Signature: Ale <br /> (Applicant) dr -2/ if 6 / <br /> Sworn to and before ,� <br /> This 3� day of /��N/�GCi/ , 20% <br /> �/�11 G/1/� <br /> 1--. ..,„,:,,,` • ioueunnro <br /> �` .°•�;. �iEE 08314' <br /> . i4�. <br /> No 'ublic. tate of Florida at Large ,�,�,:. i V.tots <br /> My Commission Expires: l(a./.0/-, <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 /> City of Sunny Isles Beach Community Development Department <br />