Laserfiche WebLink
ADDENDUM A <br /> BENEFICIAL INTEREST AND DISCLOSURE AFFIDAVIT <br /> (OTHER) <br /> E- <br /> STATE OF i"L_CAIZ)Oq ) <br /> COUNTY OF :t :� l 1 7 ) <br /> Before me, the undersigned authority, personally appeared RONALD M. ANSIN, this day of �" , 2005 , <br /> who, first being duly sworn, deposes and says : <br /> 1 ) That RONALD M. ANSIN whose address isz3`6c� L`>/O--Zcy Jlkd, • , P•7h best ' ,0etrzkra; z J- ,3 <br /> is the record owner of the EL Property. The following is a list of every "person" (as defined in Section 1 . 01 (3 ) , Florida <br /> Statutes) holding 5 % or more of the beneficial interest in the EL Property: <br /> (if more space is needed, attach separate sheet) <br /> Name Address Interest <br /> RONALD M. ANSIN 100% <br /> 2) That to the best of the affiant's knowledge, all persons who have a financial interest in this real estate transaction or who <br /> have received or will receive real estate commissions attorney's or consultant's fees or any other fees or other benefits <br /> incident to the sale of the EL Property are : <br /> Name Address Reason for Payment Amount <br /> NONE, <br /> 3 ) That, to the best of the affiant's knowledge , the following is a true history of all financial transactions (including any <br /> existing option or purchase agreement in favor of affiant) concerning the EL Property which have taken place or will take <br /> place during the last five years prior to the conveyance of title to RONALD M. ANSIN : <br /> 02 / 21 / 05 <br /> Page f3 _ <br />