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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 /> The above is a full disclosure of all parties of interest in le application-to the best of my <br /> knowledge and belief. <br /> Signature: <br /> (Applicant) S - -— Bra. - <br /> Sworn to and subscribed before me, <br /> This vZ. day of 1 " ce ,20 j <br /> L. �1t Notary Public N State PER of Florida <br /> > ∎lic,State of Florida at La ( \ ` My Comm.Eapira Mar 2,2016 F <br /> .. Commission#EE 144600 r <br /> I „' 6onds0 NNIonN Notary Assn. <br /> My Commission Expires: 3 2 1(6 <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 />