HomeMy WebLinkAboutApplication & Supporting Docsc. q
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HEARING BOARDS'°�
444 SW 2nd Avenue, 7t" Floor • Miami, Florida 33130
Telephone 305-416-2030 • Fax 305-416-2035
www.miami.qov.com/hearinq boards "Y y
OFFICIAL VACATION AND CLOSURE OF A PUBLIC RIGHT-OF-WAY
Welcome to Hearing Boards! This application is intended to serve as a guide in assisting you with our
public hearing process. Please feel free to contact us at the number above, should you have any
questions.
The deadline to file the complete application with supporting documents is the first five working days
of each month from 8:00 am until 3:00 am, except on the fifth day. at 12:00 Dm. The aDDlication
subn,_ittal date is the date stamped by Hearing Boards' staff on this page. The responses to this
application must be typed and signed in black ink. Please note that pursuant to Section 1304.2.2 of
the Miami Zoning Ordinance, no application shall be deemed to have been filed unless and until the
application shall have been completed. All pertinent and accurate information/documentation; i.e., the
plans, reports, exhibits, shall be presented at the time of filing, in addition to the paid receipt. The
applicant is responsible for the accuracy of the information contained in the application and all
supporting materials. Should you wish, you could bring the materials to our office for review before the
deadline to ensure completeness.
You will be responsible, if needed, to bring an interpreter for the English language to any presentation
before city boards, committees and the city commission. A valid power of attorney will be required if
neither applicant or legal counsel representing the applicant execute the application or desire to make a
presentation before city boards, committees and the city commission. All documents, reports, studies,
exhibits (8'/2 x11") or other materials submitted during this process will be kept as part of the record.
ORDINANCE NO. 11469, CODIFIED IN CHAPTER 2, ARTICLE VI OF THE CITY CODE STATES
THAT ANY PERSON WHO RECEIVES COMPENSATION, REMUNERATION OR EXPENSES FOR
CONDUCTING LOBBYING ACTIVITIES TO REGISTER AS A LOBBYIST WITH THE CITY CLERK,
PRIOR TO ENGAGING IN LOBBYING ACTIVITIES BEFORE CITY STAFF, BOARDS, COMMITTEES
AND THE CITY COMMISSION. A COPY OF SAID ORDINANCE IS AVAILABLE IN THE OFFICE OF
THE CITY CLERK (MIAMI CITY HALL), LOCATED AT 3500 PAN AMERICAN DRIVE, MIAMI,
FLORIDA, ::3133.
Ordinance No. 12918 states that each person or entity requesting approval, relief or other action from
the City Commission or any of its boards, authorities, agencies, councils or committees regarding any
issue, shall disclose at the commencement (or continuance) of the public hearing(s) on the issue, any
consideration provided or committed, directly or on its behalf, for an agreement to support or withhold
objection to the requested approval, relief or action. The Disclosure of Consideration Provided or
Committed for Agreement to Support or Withhold Objection Affidavit included in this package must be
submitted with the application. The applicant must, at the commencement of any public hearing on the
issue, if there is any disclosure to report, read the disclosure into the record. Also, the applicant must
supplement the affidavit if there is any new information or additional information to disclose.
Rev. 12-16-08
MIA 180,605,1550 5-18-09
Copies of City Commission resolutions and ordinances can be obtained at our website through the
"Legislative Hub", or for certified copies, contact the City Clerk's Office at 305-250-5360.
Please refer to Chapter 55 of the Miami City Code for Vacation and Closure information.
1. Applicant name(s): Iris Escarra, Esquire on behalf of Altos Pointe Investments, LLC
2. Two (2) copies of the Tentative Plat: One (1) 24 x 36" and one (1) 8'/Z x 11" prepared by a
State of Florida registered land surveyor.
3. Two (2) original sketch of surveys: One (1) 24 x 36" and one (1) 8'h x 11", prepared by a State
of Florida Registered Land Surveyor showing only the area to be vacated or closed and the
pertinent legal description of the area, within one year from the date of application.
4. Two (2) 11x17" original and one (1) 8 'h x 11 copy of the survey of the property prepared by a
State of Florida registered land surveyor within six (6) months from the date of the application.
5. Opinion of Title addressing the reversionary rights, if any. Note: An update is required if more
than three (3) months elapse before Zoning Board or City Commission approval.
6. Signed Tentative Plat letter from Public Works indicating Plat & Street recommendation.
7. The subject property(ies) cannot have any open code enforcement/lien violations.
8. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable.
9. At least two photographs showing the entire property showing land and improvements.
10. A clear and legible copy of the recorded warranty deed and tax forms of the most current year
showing the present owner(s) and legal description of the property.
11. A clear and legible copy of the subject property address(es) and legal description(s) on a
separate sheet, labeled as "Exhibit A", to match with the current survey's legal description.
12. Affidavit of Authority to Act and the Disclosure of Ownership of all owners and contract
purchasers, if applicable, of the subject property (see pages 5 and 6).
13. Original Disclosure of Consideration Provided or Committed for Agreement to Support or
Withhold Objection Affidavit.
14. Certified list of owners of real estate within 500 feet of the subject property (see pages 7 and 8).
15. For all corporations and partnerships indicated:
2 Rev. 12-16-08
MIA 180,605,1550 5-18-09
a) Articles of Incorporation;
b) Certificate from Tallahassee showing good standing, less than one (1) year old;
c) Corporate Resolution or a Power of Attorney signed by the secretary of the Corporation
authorizing the person who signed the application to do so;
d) Non-profit organizations: A list of Board of Directors less than one (1) year old.
16. What is the acreage of the project/property site? approx. 0.99 acres
17. What is the purpose of this application/nature of proposed use? To close a remnant parcel of
platted right of way and obtain an extension of time on a previous street closure for the
redevelopment of the site. See attached approved resolution 05-0106.
18. Is the property within the boundaries of a historic site, historic district or archeological zone?
Please contact the Planning Department on the 3rd Floor for information. no
19. Is the property within the boundaries of an Environmental Preservation District? Please contact
the Planning Department on the 3rd Floor for information. no
20. Cost of processing according to Section 62-156 of the Miami City Code*:
Vacation of public right-of-way:
a. Original submittal:
1. Per square foot of right-of-way $ .90
2. Minimum $ 1,200.00
b. Re -submittals:
1. Per square foot of right-of-way $ .90
2. Minimum $ 1,200.00
3. Maximum $ 1,700.00
Public hearing and public meeting mail notice fees,
including cost of handling and mailing per notice $ 3.50
*Pursuant to Ordinance 12719, all planning and zoning fees in excess of $25,000.00,
shall be pai in thgf5of a certified check, cashier's check, or money order.
Signat re Mailing Address 1221 Brickell Avenue / 20&
Name Iris Escarra
Telephone 305-579-0737 E-mail
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
Miami, FI 33131
escarraiRm law.com
The foregoing was acknowledged before me this � day of
2001, by Iris Escarra
_ who is a(n) individual/partner/agent/corporation of
a(n) lifidividual/partnership/corporation. He/She is personally known to me or who has
produced as identification and wh ;Ld,,�(,• �d not to a an oath. _
MARISOL R. GO ' ALE`
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<. •. - �Q. mission Expires Sep 17, 2010
(Stamp) '? ,� `�" mission # DO 553129
Bonded By National Notary Assn.
3 v. 12-16-08
MIA 180,605,1550 5-18-09
AFFIDAVIT OF AUTHORITY TO ACT
Before me this day, the undersigned personally appeared Iris Escarra
, who being by me first deposes and
says:
1. That he/she is the owner or the legal representative of the owner, submitting the public
hearing application as required by the Code of the City of Miami, Florida, affecting the
real property located in the City of Miami, as listed on the foregoing pages.
2. That all owners who he/she represents, if any, have given his/her full and complete
permission for him/her to act in his/her behalf for the change or modification of a
classification or regulation of zoning as set out in the foregoing petition, x including or ❑
not including responses to day to day staff inquires.
3. That the foregoing and following pages are part of this affidavit and contain the current
names, mailing addresses, telephone numbers and legal descriptions of the real
property of which he/she is the owner or legal representative.
4. That the facts, as represented in the application and documents submitted in
conjunction with this affidavit, are true and correct.
Further Affiant sayeth not.
/11
Iris Escarra / ) Z. `-''
Applicant(s) Name ( plicant(s) Signature
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowledged before me this ;7 day of
20 09 , by Iris Escarra
_ who is a(n) individual/partner/agent/corporation of
a(n) individual/partnership/corporation. He/She is personally known to me or
who has produced as identification and who did (did no a e an
oath. � % _ _-S-7
(Stamp) Si * e %Ny e dda
;?FOF r`o;°�'� 'res So 3�
4 „ Commission # bft�gPJL'.? '
MIA 180,805,155x1 5-18-09 =s®� Bonded By National
Notary Assn.
DISCLOSURE OF OWNERSHIP
List the owner(s) of the subject property and percentage of ownership. Note: The
Miami City Code requires disclosure of all parties having a financial interest, either
direct or indirect, with respect to a presentation, request or petition. Accordingly,
disclosure of shareholders of corporations, beneficiaries of trusts, and/or any other
interested parties, together with their address(es) and proportionate interest are
required. Please supply additional lists, if necessary.
Owner's Name(es) Altos Pointe Investments, LLC
Percentage of Ownership Edward D. Pascoe 100%
Subject Property Address(es) approx. 2160 SW 5 Street, 505 SW 22 Avenue,
555 SW 22 Avenue, 2173 SW 6 Street and 2143 SW 6 Street.
2. List all street address(es) and legal description(s) of any property located within 500 feet
of the subject property owned by any and all parties listed in question #1 above. Please
supply additional lists, if necessary.
Street Address(es): Legal Description(s):
none
el
Iris Escarra
Owner(s) or Attorney Name
r(s) or Attorney Signature
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowledged before me this / day of
20 C2 by Iris Escarra
_ who is a(n) individual/partner/agent/corporation of
_ a(n) individual/partnership/corporation. He/She is personally known to me or
who has produced as
oath.
(Stamp)
MIA 180,605,1550 5-18-09
JUDITH KENNEY & ASSOCIATES, P. A.
Law Offices 2001 Biscayne Blvd., Suite 3402 Miami, Florida 33137
Telephone (305) 572-1020 Facsimile (305) 572-1085
e-mail jkenney0ajkpalaw.com
OPINION OF TITLE
To: City of Miami, a municipal corporation
With the understanding that this Opinion of Title is furnished to CITY OF MIAMI,
FLORIDA, in compliance with Section 55-8 of the Miami City Code and as an
inducement for acceptance of an alley closure application covering the real property
hereinafter described, it is hereby certified that I have examined a complete Abstract of
Title covering the period from the beginning to the 30th day of April, 2009, at the hour of
11:00 p.m. inclusive, of the following described property:
Parcel 1:
Lots 5 and 6, Block 3, of Bryandale, according to the Plat thereof, as
recorded in Plat Book 9, Page 86, of the Public Records of Miami -Dade
County. Florida.
Parcel 2:
Lots 7 and 8 less the west 15.00 feet thereof, and less that portion of Lot 7
which lies within the external area formed by a 25.00 foot radius arc
concave to the northeast, tangent to the east line of the west 15.00 feet of
said Lot 7, and tangent to the south line of said Lot 7, Block 3, of
Bryandale, according to the Plat thereof, as recorded in Plat Book 9, Page
86, of the Public Records of Miami -Dade County, Florida.
Parcel 3:
Lots 9 through 17, less the west 15.00 feet thereof, Block 3, of Bryandale,
according to the Plat thereof, as recorded in Plat Book 9, Page 86, of the
Public Records of Miami -Dade County, Florida, less that part of said Lot
17 which lies within the external area formed by a 25.00 foot radius arc
concave to the southeast, tangent to the north line of said Block 3, and
tangent to the east line of the west 15.00 feet of said block (per Official
Records Book 10188, Page 657).
Parcel 4:
Lot 18, Block 3, of Bryandale, according to the Plat thereof, as recorded in
Plat Book 9, Page 86, of the Public Records of Miami -Dade County,
Florida.
And
That portion of the 10.00 foot alleyway lying Westerly of Lots 6 and 18, of
Block 3, of "BRYANDALE," according to the Plat thereof as recorded in
Plat Book 9, at Page 86 of the Public Records of Miami -Dade County,
City of Miami
May 19, 2009
Page 2
Florida. Closed, Vacated and Discontinued from public use as per city of
Miami Resolution R-05-0486.
Basing our opinion on said complete abstract covering said period, we are of the
opinion that on the last mentioned date, the fee simple title to the above-described real
property was vested in:
Altos Pointe Investment LLC, a Florida limited liability company
Subject to the following encumbrances, liens and other exceptions (if "none" please
indicate):
1. RECORDED MORTGAGES:
Mortgage from Altos Pointe Investment LLC to Mellon United National
Bank, dated May 2, 2006, recorded May 20, 2006 in Official Records Book
24546, Page 4130, of the Public Records of Miami -Dade County, Florida.
2. SPECIAL EXCEPTIONS:
a. Restrictions, dedications, conditions, reservations,
easements and other matters shown on the plat of
BRYANDALE, as recorded in Plat Book 9, Page 86, of the
Public Records of Miami -Dade County, Florida, but deleting
any covenant, condition or restriction indicating a preference,
limitation or discrimination based on race, color, religion,
sex, handicap, familial status or national origin to the extent
such covenants, conditions, or restrictions violate 42 USC
3604(c).
b. Assignment of Leases, Rents and Profits from Altos Pointe
Investment LLC to Mellon United National Bank dated May
2, 2006, recorded May 20, 2006, in Official Records Book
24546, Page 4141, of the Public Records of Miami -Dade
County, Florida.
C. Upon satisfaction of the requirements of the Miami City Code
and the Florida Statutes, the reversionary interest in the alley
will lie with the abutting property owners.
I HEREBY CERTIFY that I have reviewed all the aforementioned encumbrances
and exceptions.
The abstract reviewed was provided by Attorneys' Title Insurance Fund, Inc.
through its ATIDS database.
City of Miami
May 19, 2009
Page 3
I HEREBY CERTIFY that the legal description contained in this Opinion of Title
coincides with, and is the same as, the legal description in the proffered alley closure
application.
I, the undersigned, further certify that I am an attorney-at-law duly admitted to
practice in the State of Florida and a member in good standing of the Florida Bar.
Respectfully submitted this 19th day of May, 2009.
Judith enney
Florida ar No. 44447
2001 iscayne Boulevard
Suite 402
Miami, FL 33137
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me this 19th day of May,
2009, by Judith Kenney, who is personally known to me.
Notary Public
Print Name
My Commission Expires:
CATHERINE A. WEST
�p rxr Pie
?: � MY COMMISSION #DD787893
EXPIRES: MAY 12, 2012
Wvlf) for. Md Ihrnuyh 1st State Insurance
FAJKPALAW\Pascoe\22nd Avenue\OpinionofTitle. City of Miami Alley Closure App 5-09.doc
CFF'1 2006RO550752
OR Bk 24546 Pss 4127 - 41291 (3pss)
RECORDED 05/20/2006 07:11:28
DEED DOC TAX 28►200.00
SURTAX 21►150.00
HARVEY RUVINr CLERK OF COURT
3MARRANIV DF.FD MIAMI-DADE COUNTYr FLORIDA
Return to:
Judith Kenney & Associates, P.A.
777 Brickell Avenue
Suite 1070
Miami, Florida 331131
This instrument prepared by:
Daniel J. Serber, Esquire
Serber & Associates, P.A.
The Tumberry Plaza- Suite 801
2875 ME. 191" Street
Aventura, Florida 33180
Property Appraisers Parcel
Identification (Folio) Number(s):
(Wherever used herein the terms "first party" and "second party" shall include singular and plural, heirs, legal representatives, and assigns of
individuals, and the successors and assigns of corporations, and all pronouns and any variations thereof shall be deemed to refer to the
masculine, feminine, neuter, singular or plural wherever the context so admits or requires.,^
THIS INDENTURE, made thisfi d day of Ir m1rl jA.D. 2006. BETWEEN PUNTA
DIAMANTE, L.L.C., a Florida Limited Liability company, of the County of Miami -Dade, in the
State of Florida (party of the first part), and, ALTOS POINTE INVESTMENTS, L.L.C., a Florida
Limited L'ab'lity co pany of th County Miami -D , m the State of Florida, whose post office
address is3 SZ 2�n d A M ,4� 3J� (party of the second part).
WITNESSETH, That the said party of the first part, in consideration of the sum of Ten and 00/100
Dollars ($10.00), to it in hand paid by the said party of the second part, the receipt whereof is hereby
acknowledged, has granted, bargained, and sold to the said party of the second part, its heirs, successors, and
assigns forever, the following described land, situate, and being in the County of Miami -Dade, State of Florida,
to -wit:
PARCEL 1:
LOT 5, BLOCK 3, OF BRYANDALE, ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 9, PAGE 86, OF THE
PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
PARCEL 2:
LOTS 7 AND 8 LESS THE WEST 15.00 FEET THEREOF, AND LESS
THAT PORTION OF LOT 7 WHICH LIES WITHIN THE EXTERNAL
AREA FORMED BY A 25.00 FOOT RADIUS ARC CONCAVE TO THE
NORTHEAST, TANGENT TO THE EAST LINE OF THE WEST 15.00
FEET OF SAID LOT 7, AND TANGENT TO THE SOUTH LINE OF
SAID LOT 7, BLOCK 3, OF BRYANDALE, ACCORDING TO THE
PLAT THEREOF, AS RECORDED IN PLAT BOOK 9, PAGE 86, OF
THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
Book24546/Page4127 CFN#20060550752 Page 1 of 3
PARCEL 3:
LOTS 9 THROUGH 17, LESS THE WEST 15.0 FEET THEREOF, AND
LOTS 6 AND 18, BLOCK 3, OF BRYANDALE, ACCORDING TO THE
PLAT THEREOF, AS RECORDED IN PLAT BOOK 9, PAGE 86, OF
THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA,
LESS THAT PART OF SAID LOT 17 WHICH LIES WITHIN THE
EXTERNAL AREA FORMED BY A 25.00 FOOT RADIUS ARC
CONCAVE TO THE SOUTHEAST, TANGENT TO THE NORTH LINE
OF SAID BLOCK 3, AND TANGENT TO THE EAST LINE OF THE
WEST 15.0 FEET OF SAID BLOCK. (PER OFFICIAL RECORDS
BOOK 109188, PAGE 657).
PARCEL 4:
LOT 18, BLOCK 3, OF BRYANDALE, ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 9, PAGE 86, OF THE
PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA
SUBJECT TO:
1. Taxes for the year 2006 and subsequent years, not yet due and payable.
2. Zoning, restrictions, prohibitions, and other requirements imposed by governmental authority.
3. Restrictions and matters appearing on the Plat or otherwise common to the subdivision.
4. Public utility easements of record.
And the said party of the first part hereby covenants with said party of the second part that the party of the
first part is lawfully seized of said land in fee simple; that the party of, the first part has good right and lawful
authority to sell and convey said land; and that the party of the first part does hereby fully warrant the title to said
land, and will defend the same against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, The said party of the first part has hereunto set its hand and seal the day and
year first above written.
PUNTA DIAMANTE, L.L.C. ,
a Florida Li 'te Lei it o pany
By; onion Sutton, as its Memgiag Mo
Address: 501 Golden Isles Drive -Suite 206-B
Hallandale, Florida 33009
By: Saul Lan
Address: 501
Hallandale, F
is its Mwegifig-Mefn
:n Isles Drive -Suite 206-B
33009
Book24546/Page4128 CFN#20060550752 Page 2 of 3
OP BK 24546 PG 4129
LAST PAGE.
STATE OF FLORIDA )
:SS
COUNTY OF MIAMI-DADE }
I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and
in the County aforesaid to take acknowledgments, personally appeared Salomon Sutton and Saul Laniado, as
Managing Members of PUNTA DIAMANTE, L.L.C., a Florida Limited Liability company, who are-ueLu ally
known to me to be the person described in and who executed the foregoing instrument or who have produced
as idenfification anci who swore and acknowledged before me that he executed the same on
behalf of said company.
WITNESS my hand and official seal in the County and Statelast r aid this ay of Ap
A.D. 2006.
r
NOTARY 1� L , State of lori l ,
print
Name• - f! �'✓
My Co sion Ex fres: �/tf/�
MYRIAM K. LOUIS
?04 n�V Notary Public - State of FloOda
• :MVCommissionExpires W 4, 2008
X ' �'.' Commiulon # DD296342
Bonded ByNatlomlNotaryAssn.
3
Book24546/Page4129 CFN#20060550752 Page 3 of 3
State of Florida
Department of State
I certify from the records of this office that ALTOS POINTE
INVESTMENT LLC is a limited liability company organized under the
laws of the State of Florida, filed on March 23, 2006.
The document number of this limited liability company is
L06000031762.
I further certify that said limited liability company has paid all fees due
this office through December 31, 2009, that its most recent annual report
was filed on April 23, 2009, and its status is active.
I further certify that said limited liability company has not filed Articles
of Dissolution.
Given under tiny hand and the Great Seal of.
Florida, at Tallahassee, the Capital, this the
Nineteenth day of May, 2009
Secretary Of State
Authentication ID: 300156181573-051909-L06000031762
To authenticate this cerdficate,visit the following site, enter this
ID, and then follow the instructions displayed.
hftps://efile.sunbiz.org/certauthver.html
r"�Ut-SY OF fr ,;
FY`s CITY OFMIAMI
DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO
/, SUPPORT OR WITHHOLD OBJECTION
The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its
boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the
issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or
withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee,
commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or
implied, or any promise or agreement to provide any of the foregoing in the future.
Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or
any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners'
legal representative are not required to fill out this form.
NAME.,:
1-IOME ADDRESS:
CITY:
IONH', P[ ION.G:
F,MAIL,:
(First Name) (Middle) (Last Name)
STATE: Florida ZIP:
CELL. PHONE:
FAX:
BUSSINESS or APPLICANT or ENTITY NAME
Iris Escarra, Esq. c/o Greenberg Traurig
BUSINESS ADDRESS: 1221 Brickell Avenue
(Address Line 1)
Miami, Fl 33131
(Address Line 2)
1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board,
authority, agency, council, or committee.
Approval of street closure for property located at approximately 555 SW 22nd Avenue
2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to
support or withhold objection to the requested approval, relief or action?
❑ YES ® NO
If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If
your answer to Question 2 is Yes, please answer questions 3, 4. & 5 and read and execute the Acknowledgement.
No.:86543
3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed.
Name Address Phone#
a.
b. n/a
C.
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
n/a
5. Describe what is being requested in exchange for the consideration.
n/a
ACKNOWLEDGEMENTOh' COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal
or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing
disclosure requirement was not fully and timely satisfied the following may occur:
1. the application or order, as applicable, shall be deemed void without further force or
effect; and
2. no application froVperso entity for ame issue shall be reviewed or
considered by the until exp' atio of a period of one year after the
nullification of the r. /^
PERSON SUBMITTING DISCLOSURE �A
Signature
Print Name
Sworn to and subscribed before me this / daY of ...... _...._... ... 200...._! ._......_ The foregoing
instrument was acknowledged before me by/C!S3 who has produced
as identification and/or is pervonall naiun-to-me�and who didldid not take an oath.
STATE OF FLORIDA M ISO GG LEZ %
N P
CITY OF MI:AM[ .'.,"` St f o' a
M .
MY COMMISSION :�� .° 'Nota
06mmfssion # 312
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i?;XPIRI%S:°' ` ` Bonded By Nation a otary Assn.
�„
Pritit Name
E nCtOSUrc(s).
Doe. No.:86543 Page 2