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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 />........................................... ....::......................... I........................ ................ <br />The above is a full disclosure of all parties of interest n the applicati to the best of my <br />knowledge and belief. <br />Signature: <br />(Applicant)lrr— .I;V 7— <br />My Commission Expires: <br />kill <br />ot�av ry BRENDA E. FERNA W <br />' MYCOMMISSIONAEE16B039 <br />* * <br />EXPIRES: Febivary 8, 2016 <br />��14�FOi /0.Pp /BM�l tttV]! /'y %jf / /NOIBi�$%¢T%R2f <br />a+ 00-/& <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 />