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OWNERSHIP AFFIDAVIT <br />FOR LIMITED LIABILITY COMPANY <br />STATE OF��,O I Public Hearing No, <br />COUNTY OF Mll d A&40--t(a- <br />Before <br />me, the undersigned authority, personally appeared- SI Ay 61� :S mll c <br />hereinafter the Affiant (s), who being first duly sworn by me, on oath, deposes and says: <br />1. Affiant is the manor managing member of the Logs+ ajds+ b2U'2�OPV44 <br />EE04A £S-y-Q•Limited Liability Company with the following <br />address: <br />113 W 19 %(� -1A�-�nO�'�to�tJ _CL 33-3Z2, <br />2. The Limited Liability Conipanowns r lease (circle one) the property, which is the <br />subject of the proposed hearing. <br />3. The subject property is legally described as: <br />12IM LZ kxos. Aveyloe CAn6-�o 011i- - (IM <br />U�nDly l.tb2�91'je tn+ In er��n �lerte.n+s Q�#� 29?lq•25�!$ <br />4. Affiant is legally authorized to file this application for public hearing: <br />5. Afflant 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 hearing <br />advertized. <br />Witnesses: <br />S�tgnafufe b r� <br />llll�ilX( P 'nt VV"ine <br />Si <br />ur��C� <br />Print Name <br />/r <br />Affiant's Signature <br />IIA V//A r 17SPA2 L <br />Print Name <br />Sworn to and subscribed before the on the !!?day of 20 -al , <br />Affiant is personale known to rn;or has produced A as <br />Identification. <br />j�Notary (St up(Seal) <br />Commission Expires: to ab a l ! <br />CARMIN TILLIT <br />Notary Public - State of Florida <br />Commission # GG 192011 <br />9 oMr}O My Comm. Expires Jun 26 2022 <br />Bonded through National Notary Assn. <br />Page 10 of 23 <br />17 <br />