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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 officers, <br /> 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 /> The above is a full disclosure of all parties of interest in the application to the best of my knowledge <br /> and belief. <br /> . _- - Signature: j <br /> (Applicant) orsh J' . 'Jrttitr,.e, t Se— <br /> Sworn to and subscribed before me, <br /> This :o day of N40-I e ober ,20 %CD <br /> jo►"""pec <br /> , . SYLVIA M.MARTINEZ <br /> Notary P lic,State of Florida at Large = Notary Public-State o1 Florida <br /> J• = _ <br /> `;4 My Comm.Expires Jan 12,2019 <br /> a or,,, ••, Commission#FF 159931 ,y <br /> • <br /> My Commission Expires: <br /> * Disclosure shall not be required of any entity;the equity interest is which are regularly traded on <br /> ah 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 /> Public Hearing No: <br /> 'J-;4%t•S:iZ:3—J='.:.c%sS:+:.\�N11 :.irC:r`a=:' �..c:.• ...Tt.i�. ..r.r-C�.K.Jt. <br /> City of Sunny Isles Beach Community Development Department <br /> • <br /> 1 �I <br />