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NO CRON* J 4 ' D 'e ZW Vmi one 6-)&@ "M S M M N hp Y � x <br />TO BE ATCACHYD 10 3GREEMEtii <br />ADDLUCH <br />BENFFICIAL MYEREST rL\'3] DISCLOSURE AMDA%IT <br />(OTHER) <br />STATE OF io) <br />C C1L7v71' d <br />Before me, theundersignedauthority, personally appearedn 4 i Q I C [itis <br />day of[ja� , 14 , who, rtst being duly sworn, depire-% and says: - — <br />1) That } teA bLkIL4- T bR^+ A tWlr, I W tldf mss ig <br />•� -R � + ms s the record ow= of the Property. The <br />following is a list ofcvcrl "person" (as rlefincd in Section 1.01(1), Flmida Statutes) holding S°o or more ofthe beneficial <br />interest in the PxopcM: <br />(if more space is needed, attach separate sheet) <br />Z1d[ll� Addres hltel"est <br />33 '13 <br />4� r ifetc 71 -v --V'— 33'/3 <br />111'al r? . ,Saltj m e- s 3 3 Y3 <br />2) That to the best of the affiants knowledge, all petsrms eche have a financial interest in this real estate transaction or who <br />have received oreaill receive mnl estate eommisgi ynnsultant sees or ane' other fees or t er heUe�s incident <br />to the sale of the Property are: <br />Yame d�4cs/. aga for Pad• tnunt <br />n fCISS, <br />February 2 1y�'] <br />- <br />