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. • <br /> 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 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 of interest in the application to the best of my knowledge <br /> and belief. d/nt/yetSignature: <br /> (Applicant) //�1,�, ' 4i/1,.e U. <br /> Sworn to and subscribed •efore me, l/ <br /> day of ,20 /(-1') <br /> A: ,�/ c"'4rirte, FAWN Taff <br /> o •�+'A' bl1c, . of Flo 'da at Large ,: . i,1f ;: =<<9861t <br /> •!iw..e 26,2018 <br /> </?;;F•; 3cr:v it=,ixtzry8:s!itUrdenrr ers <br /> My Commission Expires: 6 ti <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 /> • <br /> Public Hearing No: - • <br /> City of Sunny Isles Beach Public Hearing Application Package Page 15 of 30 <br />