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If any contingency clause or contract terms involve additional parties, list all individuals or officers, if a corporation, <br />partnership or trust. <br /> <br />For any changes of ownership or changes in contracts for purchase subsequent to the date of the application, but <br />prior to the date of final public hearing, a supplemental disclosure 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 kno~ledge and belief. <br /> <br /> <br />Signature: <br />(Applicant) <br /> <br /> <br />, 200 sf <br /> <br />(Seal) <br /> <br />NOTARY PUBLIC-STATE OF FLORIDA <br />i"""""I,. Sudian Perez <br />~ ~ i Co~rnission # DD748162 <br />...,.......... Expires: MAR. 02, 2012 <br />llo!'.llED THRU ATL'.liTIC BO:,llIXG eo., L';C. <br /> <br />* <br /> <br />Disclosure shall not be required of any entity; the equity interest is which are regularly traded on an <br />established securities market in the United States or other country; or any entity, the ownership interest <br />of which are held in a limited partnership consisting of more than 5,000 separate interest and where no <br />one person or entity holds more than a total of 5% of the ownership interest in the limited partnership. <br /> <br />14 <br /> <br />City of Sunny Isles Beach <br />MIADOCS 2639498 I <br /> <br />Planning and Zoning Department <br />