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NAME, ADDRESS AND OFFICE if applicable) Percentage of Interest <br />Date of Contract: <br />If any contingency clause or contract terms involve additional parties, list all individuals or <br />officers, if a corporation, partnership or trust. <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 shall <br />be filed. <br />.......................................................................................... ............................... <br />The above is a full disclosure of all parties of interest in t application to the best of my <br />knowledge and belief. A <br />Sworn to and pbscribedb ore me, 1 <br />This r day o>1/ ) -,20/,2 <br />H. BARBARA ZEE" <br />Notary Public, State of Flmid6 at Large # , My COMMISSION #DO844054 <br />EXPIRES: February 15, 2013 <br />/'�_J J ��7F0lROP\�P Bade071wBudgefNMeryBervkec <br />My Commission Expires: d4)` / 6 113 <br />* Disclosure shall not be required of any entity; the equity interest is which are regularly traded on <br />an established securities market in the United States or other country; or any entity, the ownership <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 5% of the ownership interest in the <br />limited partnership. <br />City of Sunny Isles Beach Community Development Department <br />