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DISCLOSURE OF INTEREST <br />If the property which is the subject of the application is owned or leased by a LIMITED LIABILITY <br />COMPANY list the members or stockholders consist of another corporation(s), trustee(s), partnership(s) <br />or other similar entities, further disclosures shall be required which disclosures the identity of the <br />individual(s) (natural persons having the ultimate ownership interest in the aforementioned entity). <br />Prince of Sunny Isles LLC <br />TLC Name <br />Name, Address and Office <br />M oSeS I�AE117*) <br />;D_gVTD '-f ePe6f- <br />Percentage of Stock <br />S• <br />The above is a full disclosure of all parties of interest in the application to the best of my knowledge and <br />belief. <br />Signatures I �� <br />C"J'J �AVih i`Tr' s, f <br />(Appllsa,o: <br />NETTA GIDALI <br />Public - Stale of Florida <br />-1 ' day of " 120 (2- <br />Bonded Through National Notary Assn. <br />Notary Public, State of Florida at Large <br />My Commission <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 of <br />which are held in a limited partnership consisting of more than 5,000 separate interest and where no one <br />person or entity holds more than a total of 5% of the ownership interest in the limited partnership. <br />