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2007-417
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2007-417
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�j <br /> ADDENDUM <br /> BENEFICIAL INTEREST AND DISCLOSURE AFFIDAVIT <br /> (OTHER) <br /> Before me, the undersigned authority, personally appeared <br /> is day of VL00Oho , <br /> ("affiant"), th <br /> first being duly sworn, deposes a/nd,says: <br /> 1 ) That affiant is the ,1.1 U� �,�CC� of 194L)" cL as "First Party", whose address is <br /> / �Q /�� /4 �e otP� sYG t� ✓!!eo�hi a d in such capacity has personal <br /> knowledge of the matters set forth herein and has been duly authorized by First Party to make this affidavit on First <br /> Party' s behalf. That First Party is the record owner of Parcel One. As required by Section 286 .23 , Florida Statutes, <br /> and subject to the penalties prescribed for perjury, the following is a list of every "person " (as defined in Section <br /> 1 .01 (3 ), Florida Statutes) holding 5% or more of the beneficial interest in the disclosing entity: (if more space is <br /> needed, attach separate sheet) <br /> Name <br /> Ad�drress //'' Interest <br /> 7. <br /> •tea `>/6 3 <br /> 2) That to the best of the affiant's knowledge, all persons who have a financial interest in this real estate <br /> transaction or who have received or will receive real estate commissions attorney's or consultant's fees or any other <br /> fees or other benefits incident to the sale of Parcel One are: <br /> Name Address Reason for Pavment Amount <br /> IdD /LJ ( <br /> 3) That, to the best of the affiant's knowledge, the following is a true history of all financial transactions (including <br /> any existing option or purchase agreement in favor of affiant) concerning Parcel One that have taken place or will <br /> BLA- 133 REVISED 5/9/02 <br />
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