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OWNERSHIP AFFIDAVIT <br />FOR LIMITED LIABILITY COMPANY <br />STATE OF Fj0 L" *4 Public Hearing No <br />COUNTY OF DA0 f: <br />Before me, the undersigned authority, personally appeared <br />hereinafter the Affiant (s), who being first duly sworn by me, on oath, deposes and says: <br />1. Affiant is the manager, or managing member of the 1r/046A fj%U (')1zVAeR-2# t Ac <br />Limited Liability Company with the following <br />address: AVl- 01&7- %rJAAlc/ 4-S P/ .3a/6o <br />2. The Limited Liability Company owns or lease (circle one) the property, which is the <br />subject of the proposed hearing. <br />3. The subject property is legally described as: <br />N <br />A Ve CONDO 001 if <br />10AI 61 E)U E N k <br />Z VAv,�1 V /I <br />_771 /Q <br />MCC <br />4. Affiant is legally authorized to file this application for public hearing: <br />5. Affiant understands this affidavit is subject to the penalties of law for perjury and the <br />possibility of voiding of any zoning granted at public hearing. <br />6. Affiant understands that the matters attached to and made part of the application are <br />honest and true to the best of my knowledge and belief. I understand this application must <br />be complete and accurate before the application can be submitted and the wring <br />advertized. , .12 <br />Sworn to and subscribed before me on the 3 day of <br />Affiant is personally known to me or has produced <br />Identification. <br />Commission Expires: <br />1 s Signature <br />/yoc� <br />Print Name <br />, 20.1 , <br />as <br />sio . QG1- <br />10. <br />.g1ta <br />m <br />'Oyu UBLIC �N <br />Page 10 of 23 <br />