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OWNERSHIP AFFIDAVIT <br /> FOR LIMITED LIABILITY COMPANY <br /> STATE OF Florida Public Hearing No. <br /> COUNTY OF Miami-Dade <br /> Before me,the undersigned authority, personally appeared <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 <br /> La Playa Beach Associates. Limited Liability Company with the following <br /> address: <br /> 1000 East Hallandale Beach Blvd., Suite B, Hallandale Beach, FL 33009 <br /> 2. The Limited Liability Company owns 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 Attached <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 /> Witnesses: <br /> 111,gna .re Affiant's Signature <br /> Cam. \/AZcqu Z .00 co <br /> WM& Print Name <br /> Print Name <br /> Sworn to and subscribed before me on the I day of OCA-O /r , 20 , <br /> Affiant is personally known to me or has produced — 4 as <br /> Identification. <br /> Notary(Stam. Seal) <br /> Commission Expires: 1 2-q 5 <br /> •,o►'" ;AP:11?-4A FERREIRA <br /> 's• ,u1 ;- MY COMMISSION#FF086874 <br /> r ___ Cr F�a?; EXPIRES Jry ,2018 <br /> •tida otary5eranua 27e.com <br /> City of Sunny Isles Beach Community 4- :. : s. ment <br />