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<br />NAME. ADDRESS AND OFFICE (if applicable) <br /> <br />Percenlaee of Interest <br /> <br />Date of Contract: <br /> <br />If any conlingency clawe or coutlllct terms involve additional partie., Ii.t all individual. or <br />officers, if a corporation, partnership or trust. <br /> <br />For aoy changes of ownership or changes in contlllcts for purchase subsequent to the date of the <br />application, but prior lo the dale of Hnal public hearing, a supplemental disclosure of interest shaU <br />be filed. <br /> <br />The above is a full disclosure of all parties of in <br />knowledge and belief, <br /> <br /> <br />Signature: I' <br /> <br />Sworn to aud subscribed before me, <br />ThiS.P day of H <br /> <br /> <br />Idaat Large <br /> <br />,20 /.:2/ <br />/[i"l/i"W;;;,.' DAISY M. SOTOLONGO <br />. 1:; ;.; MY COMMISSION I 00841976 <br />'4:'. .''J.J EXPIRES: March 29, 2013 <br />.ftr.,~~" BondedThruNolaryPublieUlldelWrilers <br /> <br />My ~ommission Expires: ~~/.:2t),L3 <br /> <br />· Disclosure shall not be required of any entity; the equity interest is which are regularly traded on <br />an establisbed securities market in tbe Uniled Slates or other country; or any entity, the ownel1lbip <br />interest of which are held in a limited partnership consisting of more than 5,000 separate interest <br />and where no one person or entity holds more than a total of S% of lhe ownership interest in the <br />limited partnership. <br /> <br />- <br />City of Sunny Isles Beach <br /> <br />., .. <br />Community Development Department <br />