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<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 fmal public hearing, a supplemental disclosure of interest <br />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 />Signature: <br /> <br />~0~1 ,- <br />~ (/ <br />., . <br /> <br /><LI nnu k l.ee f)(1.4'CO-rP <br />I () <br /> <br />(Applicant) <br /> <br />Sworn to and subscribed before me, <br /> <br />This (3/ day of <br /> <br />M;Ccl <br />J <br /> <br />,? 7/.1 <br />,~X~~, <br /> <br />(Seal) <br /> <br />'~~~P.(2 08.41/12t <br />Notary Public, State of Florida at Large <br /> <br /> <br />.....~~."", PAULlNA COHEN <br />~~\ Notary Public, State of Florida <br />: . . ' j My Comm. Expires Feb 11, 2015 <br />\~ Cf:.'# Commission II EE 59033 <br />":",...t.\,,'" Bonded Througll Hllillnal NOlarr Assn. <br /> <br />My Commission Expires: ..:2;/II,,/J2/JI!? <br /> <br />* Disclosure shall not be required of any entity; the equity interest is which are regularly traded <br />on an established securities market in the United States or other country; or any entity, the <br />ownership interest of which are held in a limited partnership consisting of more than 5,000 <br />separate interest and where no one person or entity holds more than a total of 5% of the <br />ownership interest in the limited partnership. <br /> <br />City of Sunny Isles Beach <br /> <br />1.5 <br /> <br />Planning and Zoning Department <br />