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T- <br />M <br />NAME, ADDRESS AND OFFICE (if applicable) Percentage of Interest <br />Date of Contract: <br />If any contingency clause or contract terns 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 ofintere <br />and beliet'zArA±T <br />Signature <br />�w►et(Applican <br />Sworn to and subscribed before me, <br />This V day of Maty , 20 ZJr <br />Ak:W&-1 <br />Notary u lic, S at o Ma at Large <br />My Commission Expires: 'S •3l• 0Zs <br />r;►"' P ai,,. NotarY pubitC - Stale 011 itatida <br />Commission # HH 089412 <br />trey M>•Y 31, 2025 <br />µy Comm. EAP Assn. <br />10 9t, t1vanal Nalat <br />nnded <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 />Public Hearing No: <br />City of Sunny Wes Beach Public Hearing Application Package Page 16 of 23 <br />