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<br />. <br /> <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 <br />shall be filed. <br /> <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 /> <br />Signature: <br /> <br /> <br />~~ <br /> <br />(Applicant) <br /> <br />. Sworn to and subscribed before <br /> <br />This day of <br /> <br /> <br />,20i2L <br /> <br />(Seal) <br /> <br />at Large <br />lOA <0:- ~ <br /><l1."'h~ <br />'% ':.t;o ~ ~~ <br />'i'i ~ .~'O <br />"'~ ~ 'llb ~ <br />My Commission Expires: ~~~'~ ::t#~~ <br />~*"",;;. l.f, r <br />~ 'd ~ <br />* Disclosure shall not be required oF'~~ntity; the equity interest is which are regularly traded <br />on an established securities market i~ the United States or other country; or any entity, the <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 5% of the <br />ownership interest in the limited partnership. <br /> <br />. <br /> <br />City of Sunny Isles Beach <br /> <br />15 <br /> <br />Planning and Zoning Department <br /> <br />23 <br />