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OWNERSHIP AFFIDAVIT <br /> FOR LIMITED LIABILITY COMPANY <br /> STATE OF d//L'LiC•&. Public Hearing No. <br /> • COUNTY OF �1L <br /> Before me,the undersigned authority,personally appeared .PA P.M V-AeS 1 h nr t 1 S <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 17550 Collins Avenue, LLC <br /> a Florida Limited Liability Company with the following <br /> address: <br /> 1450 Bricks!' Avenue, 18th Floor, Miami FL 33131 <br /> 2. The Limited Liability Company CD 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 /> See Exhibit"A" attached <br /> • <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 perjury and the <br /> possibility of voiding of any zoning granted at public hearing. <br /> 6. Affiant understands that the matters attached to and made part of the application are <br /> honest and true to the best of my knowledge and belief.I understand this application must <br /> be complete and accurate before the application can be submitted and the hearing <br /> advertized, <br /> itne 0e <br /> /,'7 U - <br /> Signatura Affient's Signature <br /> put/ /sarl/G PA .-utS }iNSTA�A� TES. <br /> N:r Print Name <br /> Signature <br /> 60' �l1�9 Gi✓i-� ' <br /> Print Name <br /> Sworn to and subscribed before me on the 69 2day of /11/ 20 Lt, <br /> Affiant is personally known to me or has produced / `as / <br /> Identification. J 4 L c/'1 4 ,-%'b/11 /GA t y <br /> Commission Expires: !i� "?Notary es RYA <br /> P �?(� i' MY COMMISSION#FF127899 <br /> '7:f f./ EXPIRES June 1, 2018 /V <br /> (4071398.0193 FlorldallotaryaaMcecom / <br /> City of Sunny Isles Beach . Community Development Department <br />