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1 I .r rr <br /> DISCLOSURE AFFIDAVIT FOR TRUST <br /> STATE OF FLORIDA <br /> COUNTY OF INDIAN RIVER <br /> BEFORE ME , the undersigned authority, personally appeared NEIL J . GAETA, TRUSTEE, whose <br /> mailing address is 5220 Hood Road , Suite 100, Palm Beach Gardens, FL 33418. <br /> Affiant , who , being by me first sworn , on oath , deposes and says : <br /> 1 . Affiant is the Trustee of the above-referenced Trust. ' <br /> 2 . The Trust is the fee simple owner of the property located in Indian River County, Florida , and legally <br /> described on Exhibit " A" attached hereto and by this reference made a part hereof ("Property') . <br /> 3. Affiant, as a Trustee of such Trust , intends to convey the Property to Indian River County , a political <br /> subdivision of the State of Florida . <br /> 4 . The names and addresses of the persons holding a beneficial interest in the Property, and respective <br /> shares held by same as of today are as follows : <br /> 5 . The above disclosure is made to the Chairman of the Indian River County Board of <br />County <br /> Commissioners , as required under Section 286.23, Florida Statutes . <br /> 6 . Affiant has made the disclosure contained herein under oath subject to and with full knowledge of the <br /> penalties prescribed for perjury under the laws of the State of Florida. <br /> FURTHER AFFIANT SAY W <br /> H . <br /> (sign) <br /> nx <br /> ea rustee <br /> Date <br /> I HERESY CERTIFY that the foregoing instrument was subscribed and sworn to before me this <br /> ^ <br /> day of \- ��s�� , 200 `� , by Neil J . Gaeta , Trustee. He is personally known to me or <br /> produced /.l �l s�� � �� _ 1c .�rt - as identification . <br /> Notary Public : <br /> Sign <br /> Stamped seat with name , Commission <br /> Number & Expiration Date: <br /> WOMERSLEY S o � �Lak rO,p <br /> 10594@196885 <br /> a a a a p a U al a a a U• a OO a a a u• a a a a• = <br /> NANCY <br /> a++++++r+,,, Comm# DD0692885 <br /> Expires 711312011 • <br /> Assn., Inc saw <br /> Florida Notary <br /> Auu.uaaN.easceoaunua aHeuanuauuu� <br />