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<br />If any contingency clause or contract terms involve additional parties, list all individuals <br />or officers, if a corporation, partnership or trust. <br /> <br />For any changes of ownership or changes in contracts for purchase subsequent to the date <br />of the application, but prior to the date of final public hearing, a supplemental disclosure <br />of interest shall be filed. <br /> <br />The above is a full disclosure of all parties of interest in the application to the best of my <br />knowledge and belief. <br /> <br /> <br />(Applicant) <br /> <br /> <br /> <br />, 1 rc,wTe.,. <br /> <br />Sworn to and subscribed before me, <br /> <br />This ,~~ day of-d v Tl.Jf <br /> <br />, 200 Lf <br /> <br /> <br />(Seal) <br /> <br />My Commission Expires: <br /> <br />..........IU.."..... <br />1......."...........N..I~!I!.U~.:..l G MILANO : <br />. \\\"'~ ~. : <br />! 4~' ~'\ Commission. 000180238 ; <br />: f1~ a Expires 2/1 &2007 : <br />..", "'- . <br />: \~1'oHI.'i;j".f'..i ['ended th~Ol!gh : <br />i(D;;~;t~~'~". :~-:' ",: '..~~.' '. .:".: !:.~:,.~ <br />............ <br /> <br />* Disclosure shall not be required of any entity; the equity interest is which are regularly <br />traded on an established securities market in the United States or other country; or any <br />entity, the ownership interest of which are held in a limited partnership consisting of <br />more than 5,000 separate interest and where no one person or entity holds more than a <br />total of5% of the ownership interest in the limited partnership. <br /> <br />. -,_._.,,~.~..~..- -.-' <br />...-- ....-...._...... ..... <br /> <br />. ---- ...-.. -.. - <br />-............... '." <br /> <br />....... --.. <br />''''', -..... <br /> <br />:- -.~-' -;''''.J':':' .=' :..0\."'.:',,''''';;:. '?'_-""'';''''':__''-~':'':Z::''''<:;'''-::::$~';:.,,__ . <br /> <br />Planning and Zoning Department <br /> <br />City of Sunny Isles Beach <br />