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<br />If any conti ency clause or contract terms involve additional parties, list all individuals <br />or officers, if a fPOration, partnership or trust. <br /> <br /> <br />For any changes of ownership or changes in contracts for purchase subsequent to the date <br />of the application, but prior to the date of final public hearing, a supplemental disclosure <br />of interest 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 />X Signature: <br />(Applicant)Yo..J e ~u v\ ~ C. Y' I 1I f <br /> <br />!l~aA4U~ <br /> <br />~ Sworn to and subscribed before me, <br />This 13th day of.J)eC Qnl P-zJ ,200 lo <br /> <br /> <br />(Seal) <br /> <br />o<..,.f',Y PU<9<.... Christy Leahy <br />: ~ c; Commission # DD325033 <br />~, \) # Expires June 1, 2008 <br />~ OF !'\.~ Bonded Troy Fain In."rance.lnc. 800-3Il5.701. <br /> <br />Notary Public, State <br /> <br />My Commission Expires: lo--j-O'6 <br /> <br />* Disclosure shall not be required of any entity; the equity interest is which are regularly <br />traded on an established securities market in the United States or other country; or any <br />entity, the ownership interest of which are held in a limited partnership consisting of <br />more than 5,000 separate interest and where no one person or entity holds more than a <br />total of 5% of the ownership interest in the limited partnership. <br /> <br />i~.";::'.:.7.c"Z:~:~:~~!:':S::.:...--:::r~=,:,"=,:-:,:,~=:,:::::",=~::'l.-::;r....".!:":Z::._~:-:-:. :.:.:'=~':,~:- ':'~':_: :"'~ .:,.::.-.:.';.::....'.::-: ::::~i~'.': .~=..~:,:.O:..-=~ :..:~::::::::::;:!:~:..~-',::...:...::-:::::...~~O::;;:~:l:..::..7~c.:;.."::;_?';;;.':~~~.:..."2.::.::-'::".,~~ ".r~: :::::.: ':' ;".' :~:, <br /> <br />City of Sunny Isles Beach <br /> <br />Planning and Zoning Department <br />