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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 the application to the best of my <br /> knowledge and belief. fige7" <br /> • Signature: �� <br /> (Applicant) COI UOrCIO rnerl j <br /> Sworn to and subscribed before me, // <br /> This- 4-- —day of—M arck-L —� - - ,20-16 <br /> ota', Public,State of Fl uride at Large p�"7ct, SABRINA FERREIRA <br /> `r) MY COMMISSION#FF08B874 <br /> 1 .Lr} I'Q •�a EXPIRES January 27.2018 <br /> My Commission Expires: // G taan 39eo153 <br /> FbrlCaHotarySelNR.tom <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 />