Laserfiche WebLink
r <br /> 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 /> The above is a full disclosure of all parties of interest in the application to the best of my <br /> knowledge and belief. 4 <br /> Signature: A(k(Applicant) e---(• `1, ).2 2- A\ "' <br /> Sworn to and subscribed before me, <br /> This r" day of ,a" •' ,20 YL <br /> // / --'_-------"-- <br /> I y MIKHAEL E.KEIFITZ <br /> Notary P e • F a at Large -, w NOTARY PUBLIC <br /> � F'.~ STATE OF FLORIDA <br /> . Comm#EE153973 <br /> My Commission Expires:, <br /> ' Expires 12/18/2015 <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 />• <br /> City of Sunny Isles Beach Community Development Department <br />