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<br />DISCLOSURE OF INTEREST
<br />
<br />If the property, which is the subject of the application, is owned or lease by a PARTNERSHIP or LIMITED
<br />PARTNERSHIP, list the principals of the pannership, including general and limited partners, {Note; where the
<br />other similar entities, funher disclosures shall be required which disclosures the identity of the individual (s) (natural
<br />person) having he ultimate ownership interest in the aforementioned entity}.
<br />
<br />!Ie.! I " ~ / , '. /
<br />/">. ( );.~ "4-0/.../,,,,,1/0/." I ,/i- t/~
<br />PARTNERSHIP OR LIMITED PARTNERSHIP NAME
<br />
<br />NAME AND ADDRESS
<br />
<br />PERCENTAGE OF OWNERSHIP
<br />
<br />/.) C } .', /1 /0'7', c::
<br />>'l _ 'LL;/ rc,
<br />, __.-I j .,..... . e'/
<br />hr.", ..t."1.;L.pr.f/~~r,'('';~'d/, ,/,,,,(", /0 .''v
<br />. i/~A~:o; -5.:.~;.(,-v 7?J.s' ,.' i,/(: '<-V';"~
<br />,::: (; /'>" Cl..- /> - "y eX;
<br />4;', ' L:ro,/-
<br />/~{~;/","A 1.'0_ /1 L'r:'.'
<br />{-I;.2., ,.' 57 _.'1/'/ Z-c~ (,,,,'/.1 ~ 0";;
<br />{J,;:'34 ~v.'~'//'n.-."'/.s/ ..t:.-1.-(..... .-;r.q.{,
<br />If there is a CONTRACT FOR PURCHASE, whether contingent on this application or not and whether a
<br />Corporation, Trustee or Pannership list the names of the contract purchasers below, including the principal officers,
<br />stockholders, beneficiaries or partners. {Note; where the principal officers, stockholders, beneficiaries or partners
<br />consist of another corporation, trust, partnership or other similar entities, funher disclosure shall be required which
<br />discloses the identity of the individual (s) (natural persons) having he ultimate ownership interest in the
<br />aforementioned entity}.
<br />
<br />NAME
<br />
<br />NAME. ADDRESS AND OFFICE (if applicable)
<br />
<br />Percenta~e of Interest
<br />
<br />Date of Contract:
<br />
<br />7
<br />
<br />FTL 301675.1
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