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<br />. <br /> <br />For Jny 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 <br />shall be filed. <br /> <br />The above is a full disclosure of all parties of interest III the application to the best of my <br />knowledge and belief. ! <br />i <br /> <br />/} <br /> <br />." f: "...' j:~ ! if _ <br />I J' I.., ... ,1 .:J <br />Signature' ''-.. ..:>.j i) '';-'''''---1 <br />',.: I ..... ::;,r I ! <br />tf \. - ... . ./ ". ,,. <br /> <br />(Applicant) <~~01if0J (lJjftlft . <br />'j! <br /> <br />.I <br /> <br />Sworn to and subscribed before me, <br /> <br />This / / <br /> <br />day of Sep Ie,." heJC. <br />I <br /> <br />,200 7 <br /> <br />Notary <br /> <br /> <br />(Seal) <br /> <br />. <br /> <br />M C ~ . . E . <br />Y ommlSSlon xplres: <br /> <br />:.. I' ............. II .........,............... <br />: M. ELENA Del CAMPluo : <br />i .~ CorrmI ~)00a3 i <br />: I ~ . E-. 7/tCW2D10 : <br />~..$ ~ bded by (800)432~ i <br />~ "I"~l~'\\~ Flonds Notary Assn Inc : <br />iIlI.r "I "'" ...,. ,".., "............ I: .. '" <br /> <br />* Disclosure shall not be required of any entity; the equity interest is which are regularly traded <br />on an established securities market in the United States or other country; or any entity, [he <br />ownership interest of which are held in a limited partnership consisting of more than 5,000 <br />separate interest and where no one person or entity holds more than a total of 59'0 of the <br />owner':hip intere~t in the limited partnership. <br /> <br />ty of Sunny Islcs Beach <br /> <br />-. - - <br /> <br />~ I'll <br /> <br />14 <br /> <br />Planning and Zoning Department <br /> <br />35 <br />