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ARM2MUM <br />BENEFICIAL INTEREST AND DISCLOSURE AFFIDAVIT <br />(OTHER) <br />STATE OF <br />COUNTY OF /Iy-014A.� jR"W Az <br />Before me, the undersigned authority, personally appeared /f0 &F914 A �L�ivh1 <br />("affiant"), this Zq day ofIif4_, 19f, who, first being duly sworn, <br />deposes and says: <br />1 ) That ���JZ� �L�N/`' , whose address is <br />LIGE /Xk ."ey is the record owner of the Property. As <br />required by Section 286.23, Florida Statutes, the following is a list of every <br />"Person" (as defined in Section 1.01(3), Florida Statutes) holding 5% or more of <br />the beneficial interest in the disclosing entity: <br />fi= <br />(if more space is needed, attach separate sheet) <br />2 117'6r S*,&) So <br />I <br />r ClC <br />2) That to the best of the affiant's knowledge, all persons who have a <br />financial interest in this real estate transaction or who have received or will <br />receive real estate commissions --attorney' a or consultant's fees or anytom} <br />fees or other ben fits incident to the sale of the Property are: <br />K= &ALM Reason for Payment Amount, <br />Page 11 <br />05/05/97 ii:09AM <br />MULTIASG.GH <br />