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HEARING BOARDS
444 SW 2nd Avenue, 7`" Floor + Miami, Florida 33130
Telephone 305-416-2030 + Fax 305-416-2035
www.miamigov.com/hearing.. boards
SPECIAL EXCEPTION
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 prn, except on the fifth day, at 12:00 prn. The application
submittal 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 Y2 x11") or other materials submitted during this process will be kept as part of the record.
An additional fee to record Zoning Board resolutions will be charged, and it is determined contingent upon
fees charged at the time of recordation by the Miami -Dade County Recorder's Office at 22 NW First Street,
First Floor. Upon arrival, ask for a certified copy of the Zoning Board resolution. They will keep the original,
but please have them mail it to us at the address above, and bring the certified copy to our office. Copies of
City Commission resolutions/ordinances can be obtained at our website through the "Legislative Hub", or for
certified copies, please contact the Office of the City Clerk at 305-250-5360 or at 3500 Pan American Drive.
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, 33133.
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.
Applications given to customers do not constitute action from the City of Miami without plans review and
written comments from the Office of Zoning.
Rev. 04-21-09
Please refer to Article 16 of the Miami Zoning Ordinance for Special Exception information.
David E. Sacks, Esq. on behalf of Ken Hill Investment
1. Applicant name(s): Group, Inc.
2. Subject property address(es) and folio number(s): 921 N Venetian way, Miami,
FL 33139; Folio No. 01-3231-026-0100
3. One (1) original survey dated within six (6) months from the date of application prepared by a
State of Florida registered land surveyor.
4. One (1) original 24x36" plan,. .signed and sealed by a State of Florida registered architect or
engineer showing property boundaries and proposed structure(s), parking, landscaping, etc.;
building elevations and dimensions and computations of lot area and building spacing.
5. Bring the original 2436" plan to Hearing Boards to be stamped, dated and initialed by a
designee and then by the following departments before the application is filed:
a) Department of Public Works on the 8" Floor;
b) Office of Zoning on the 0 Floor;
c) Planning De artment on the 3d Floor.
Note: If comments are generated by any of the above, you must return to the architect or
engineer to have those comments incorporated into the plans, and you must begin #5
again. Plans are to be submitted to Zoning for first time review starting from the 8th
through the 20th of each month. Zoning will not be accepting first-time review plans after
the 20th day of the month.
6. After obtaining signatures from the above departments, two (2) 11x17" and one (1) 8'/2x11"
copies of the original plan, in addition to the survey.
7. Original and current Zoning Referral and Zoning Write -Up signed by Office of Zoning designee.
8. The subject property(ies) cannot have any open code enforcement/lien violations, unless the
request, if granted, would remedy the violation.
9. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable.
10. At least two photographs showing the entire property showing land and improvements.
11. 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.
12. 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.
13. Affidavit of Authority to Act and the Disclosure of Ownership of all owners and contract
purchasers, if applicable, of the subject property (see pages 4 and 5).
14. Original Disclosure of Consideration Provided or Committed for Agreement to Support or
Withhold Objection Affidavit.
15. Certified list of owners of real estate within 500 feet of the subject property (see pages 6 and 7).
2 Rev. 04-21-08
16. For all corporations and partnerships indicated:
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
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,
17, What is the acreage of the project/property site? 16,000 Square Feet
Corporation
18. What is the purpose of this application/nature of proposed use? Special Exception
for construction of a single family docking facility
19. 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
20. is the property within the boundaries of an Environmental Preservation District? Please contact
the Planning Department on the 3rd Floor for information. No
21, Cost of processing according to Section 62-156 of the Miami City Code*:
a, Special Exception requiring automatic City Commission review $ 2.000.00
b, Special Exception $ 800.00
c. Extension of time for Special Exception
d. Nonsubstantial modification
Public hearing and public meeting mail notice fees,
$ 500.00
$ 400.00
including cost of handling and mailing per notice 5n (x 2- zoning,,
City Commission)
Surcharge equal to applicable fee from item above, not to exceed eight hundred dollars
($800.00) except from agencies of the city; such surcharge to be refunded to the
applicant if there is no appeal from the applicant or a property owner within five hundred
(500) feet of the subject property.
*Pursuant to Ordinance 92 19, all planning and zoning fees in excess of $25,000.00,
sh a /I be A,'Zlherf a certified check, cashier's check, or money order.
Signature Mailing Address 2 S. Biscayne Blvd., Suite 2400
Name David E.'Sacks, Esq. Miami, Florida 33131
Telephone
305-379-2425
E-mail dsacks@pathmanlewis.com
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing wa acknowledged before me this
20 10 , by _ _ ��� A . o c'
who is a(n) individuali,-R-- r7agenfi/corporation of
individual/partnership/corporation..She,,s per'
- - - -°as�lidetifiea#ian and who did (did r
(Stamp)
3
J day of /1112pel-I
a(n)
orally known to -m or-who-hes-pry®d
CANDIDA CONDE
MY COMMISSION N DD 922838 Rev. 04-21.09
EXPIRES: November 25,2013
Bonded Thru Notary Public Underwriters
THIS INSTRUMENT PREPARED BY,
QAVID E. SACKS, ESQUIRE
PATHMAN LEWIS, LLP
Suite 2400, One Biscayne Tower
2 South Biscayne Boulevard
Miami, Florida 33131
RESOLUTION OF
KEN HILL INVESTMENT GROUP, LLC
1, Michael Ingram, as Secretary of KEN HILL INVESTMENT GROUP, INC
a Texas domestic for-profit corporation (the "Company") hereby certify that the
following Resolution has been duly adopted by all Managers and Members of the
Company on this 4th of March, 2010, the Resolution Is in conformity with the
Company's Articles of Organization and Operating Agreement, which are In full
force and effect on the date hereof, and have not been modified or rescinded:
BE IT RESOLVED, the Company has made, constituted and appointed,
and by these presents does make, constitute and appoints DAVID E, SACKS,
individually, as Its Authorized Representative for the Company and in its stead to
execute any and all documents in connection with the Special Exception Hearing
Application to the City of Miami. The Company hereby gives and grants unto
DAVID E. SACKS, ESQ., full power and authority to do and perform all and every
act and thing whatsoever requisite and necessary to be done in and about the
promises as fully to all intents and purposes, as it might or could do if personally
present, with full power of substitution and revocation, hereby ratifying and
confirming all that this said attorney or his substitute shall lawfully do or cause to
be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal as the
Managing Member of the Company this 4th , of March, 2010,
;57 4
KEN HILL INVESTMENT GROUP, INC.,
a Texas domestic for-profit corporation
BY:
— 91-0el I W, as Secretary
STATE OF FLORIDA )
) SS
COUNTY OF MIAMI-DADE )
The foregoing instrument was acknowledged before me this 4thday of
March, 2010, by Michael Ingram, as Secretary of KEN HILL INVESTMENT
GROUP, INC., a Texas domestic for-profit corporation. He is personally known to
me or has produced a drivers license as identifica ' nand did t p k a oath.
1K. KAISER G
My COMMISSION EXPIRES Print Name:
1�,a►13 Notary Public a u Ia `
Commission Expires:
rAhill kenlhill ken - dock matlersWocMeorporate resoludon.doc
e .r
AFFIDAVIT OF AUTHORITY TO ACT
Before me this day, the undersigned personally appeared
David E. sacks , 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, ❑ 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.
David E. Sacks, Esq.
Applicant(s) Name
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing was acknowled ed before me this S-1 day of /
)WJ
20 by
who Is a(n) individual/pert , /agent/corporation of '
a(n) individua[/partnership/corporation.el IShe i personally known to e- 6T"%
has produced as identification and who-.; id-(didrro'- =te-an-eater
(Stamp) g4nature
4?? % CANDIDA CCND'
=�: ,,. E ,� Rev. 04-21-09
MY COMMISSION N pD g2P8a6 is
"?�, oQ� EXPIRES: November 25 20 �
Rf �fh'e•` bonded Thru Notary Publ(c Undenvrifar;; I'•,
DISCLOSURE OF OWNERSHIP
1. 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) Ken Hill Investment Group, Inc.
Percentage of Ownership 100
Subject PropertyAddress(es) 921 N. Venetian Wa
Miami, FL 33139
*SEE ATTACHED EXHIBIT "1" FOR INFORMATION ON OWNERSHIP OF KEN
HILL INVESTMENT GROUP*
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):
Not Applicable
David
David E. Sacks, Esq.
Owner(s) or Attorney Name E Owner(s) or Attorney Signature
STATE OF FLORIDA COUNTY OF MIAMI-DADE
The foregoing was acl
20 ffl , by —&V P
who is a(n) individuaVpo
a(n) individual/partners
has produced
(Stamp)
E1
before me this �,: _ day of
rage nticorporation of- /V.<C-L1!1E - '
)rporation. he is p-n-%Cia --m�own tom or who
as identification and who i.d-~; 'cid dt) take" doh
Sig afure
r
CANDIDACONDE
- MY COMMISSION # DD 922636
EXPIRES, November 25, 2013 Rev. 04-21-09
bonded Thru NotaryPubllc Undenvritersn`-r
EXHIBIT "A"
Property Address
921 N VENETIAN WAY, MIAMI, FLORIDA 33139
Legal Description
Lot 13, Block 1, of RESUBDIVISION OF PORTION OF BISCAYNE ISLAND,
according to the Plat thereof, as recorded in Plat Book 40, at Page 34, of the
Public Records of Miami -Dade County, Florida.
rAhill ken\hill ken - dock matters\docs\exhibit a to special exception hearing application.doc
EXHIBIT "1"
TO DISCLOSURE OF OWNERSHIP
NATIONAL HEALTH SYSTEMS, INC.
(100% OWNER OF KEN HILL INVESTMENT GROUP, INC.)
• Ken Hill Investment Group, Inc. is 100% owned by National Health
Systems, Inc.
• Address is:
National Health Systems, Inc.
101 Jim Wright Freeway South
Suite 200
Fort Worth, Texas 76108
• National Health Systems, Inc.'s Shareholder Names, Percentages of
Ownership, and Addresses are attached hereto.
rAhill ken\hill ken - dock matte rs\docs\exh i bit 1 -disclosure of ownership.doc
SHAREHOLDERS OF NATIONAL HEALTH SYSTEMS, INC.
Current Percentage Remaining
Shareholder Name Shares Ownership Options
Ken Hill, Sr.
52,480
58.761%
The Scamper Hill Trust
12,900
14.444%
Kenny Hill
12,900
14.444%
David Hill
-
0.000%
Beverely Hill
892
0.999%
Mack Ed Swindle
860
0.963%
Dan Addison
-
0.000%
Bennie Hill
892
0.999%
Mark A. Stalzer
430
0.481%
Benjamin E. Loy
287
0.321%
Jeff Farris
227
0.254%
Rex W. Stamerjohn
134
0.150%
Rusty Dunnahoo
107
0.120%
Ronald D. Morehead
107
0.120%
Craig A. Nelson
-
0.000%
Bea Allen
107
0.120%
James D. Cummins
107
0.120%
Bob Beckley
-
0.000%
Kyle English
54
0.060%
Betty J. McCray
54
0.060%
Jim Pace
54
0.060%
Mark McCray
45
0.050%
Dewitt McClaran
43
0.048%
Kristina Dale
33
0.037%
Al Esparza
27
0.030%
Heath Garcia
27
0.030%
J. T. McCray
27
0.030%
Jo Ann Tarpley
27
0.030%
Todd Whitley
5
0.006%
Charles F. Best
27
0.030%
Dave Reeder
27
0.030%
Todd Crosslin
22
0.025%
Cindy Feneley
-
0.000%
Amy Woods
19
0.021%
Jasmina C. St.Louis
27
0.030%
Bill Brownson
16
0.018%
Jason Adama
13
0.015%
Cary Deaver
13
0.015%
Charles Muncy
13
0.015%
Julie Seaman
13
0.015%
Richelle Aldrich
-
0.000%
Cheryl A. Burgess
13
0.015%
Emily C. Stanton
13
0.015%
Robin Reese
13
0.015%
Bobby Davis
-
0.000%
Kathleen A. Johnson
11
0.012%
Tammy Connelly
11
0.012%
Merrie Stewart
-
0.000%
Julie Goodson
5
0.006%
Marlisa Johnson 3 0.003%
Rhonda Hill 892 0.999%
David Hill 2006 Trust 4,474 5.009%
David Hill Irrevocable Trust 860 0.963%
89,311 100.000%
ADDRESSES OF
SHAREHOLDERS OF NATIONAL HEALTH SYSTEMS, INC.
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BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY
Page 1 of 1
UCC I BusinessOrganizations I Trademarks I Notary I Account I Help/Fees Briefcase
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BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY
Filing Number: 79317200 Entity Type: Domestic For -Profit
Corporation
Original Date of Filing: April 14, 1986 Entity Status: In existence
Formation Date: N/A
Tax ID: 17521274971 FEIN:
Duration: Perpetual
Name: Ken Hill Investment Group, Incorporated
Address: 101 JIM WRIGHT FWY S STE 200
FORT WORTH, TX 761082202 USA
_REGISTERED FILING ASSUMEDASSOCIATE_D__
AGENT HISTORY NAMES MANAGEMENT NAMES ENTITIES
Name Address Inactive Date
Jeff Farris 101 Jim Wright Freeway South, Suite 200
Fort Worth, TX 76108 USA
Order Return to Search
Instructions:
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BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY
Filing Number: 79317200 Entity Type: Domestic For -Profit
Corporation
Original Date of Filing: April 14, 1986 Entity Status: In existence
Formation Date: N/A
Tax ID: 17521274971 FEIN:
Duration: Perpetual
Name: Ken Hill Investment Group, Incorporated
Address: 101 JIM WRIGHT FWY S STE 200
FORT WORTH, TX 761082202 USA
REGISTERED FILING ASSUMED_ ASSOCIATED 11
AGENT HISTORY NAMES MANAGEMENT NAMES ENTITIES 11
Name
ADX, INC.
Ken Hill Investment Group,
Incorporated
Order Return to Search
Name Status Name Type
Prior Legal
In use Legal
Name
Inactive Consent
Date Filing #
July 8, 2008
Instructions:
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Filing Number: 64410600 Entity Type: Domestic For -Profit
Corporation
Original Date of Filing: February 22, 1983 Entity Status: In existence
Formation Date: N/A
Tax ID: 17518693951 FEIN:
Duration: Perpetual
Name: NATIONAL HEALTH SYSTEMS, INC.
Address: 101 JIM WRIGHT FREEWAY SUITE 200
FORT WORTH, TX 76108-2253 USA
REGISTERED FILING ASSUMED ASSOCIATED
AGENT _ HISTORY NAMES MANAGEMENT NAMES ENTITIES _
Name Address Inactive Date
Jeff Farris 101 Jim, Wright Fwy. South, Ste. 200
Fort Worth, TX 76108 USA
Order Return to Search
Instructions:
0, To place an order for additional information about a filing press the 'Order' button.
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BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY
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Filing Number: 64410600 Entity Type: Domestic For -Profit
Corporation
Original Date of Filing: February 22, 1983 Entity Status: In existence
Formation Date: N/A
Tax ID: 17518693951 FEIN:
Duration: Perpetual
Name: NATIONAL HEALTH SYSTEMS, INC.
Address: 101 JIM WRIGHT FREEWAY SUITE 200
FORT WORTH, TX 76108-2253 USA
REGISTERED FILING ASSUMED ASSOCIATED
AGENT HISTORY NAMES MANAGEMENT NAMES ENTITIES
View
Document
Image
Number
Q
4901543
1983
4901544
4901545
July 13, 1983
4901546
November 13,
4901536
No
4901537
1984
4901538
Q
4901539
No
4901540
1989
4901541
July 19, 1993
4901542
No
7459202
25732480001
Filing Type
Articles of Incorporation
Articles of Amendment
Articles of Amendment
Articles of Amendment
Articles Of Amendment
Articles Of Amendment
Articles Of Amendment
Articles Of Amendment
Articles Of Amendment
Articles Of Amendment
Articles Of Amendment
Public Information Report
(PIR)
Public Information Report
Effective Eff. Page
Filing Date Date Cond Count
February 22, February 22, No 3
1983 1983
February 28, February 28, No
1983
1983
April 25,
April 25,
No
1983
1983
July 13, 1983
July 13, 1983
No
November 13,
November 13,
No
1984
1984
January 26,
January 26,
No
1989
1989
July 19, 1993
July 19, 1993
No
October 31,
October 31,
No
1996
1996
August 21,
August 21,
No
1997
1997
March 17,
March 17,
No
1998
1998
March 8,
March 8,
No
1999
1999
December 31,
December 31,
No
2001
2001
December 31,
February 3,
No
2
3
2
2
5
3
4
2
2
2
1
1
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Order Return to Search
2002 2003
Page 2 of 2
December 31,
October 2,
(PIR)
Q
43390780001
Public Information Report
November 18,
November 18,
(PIR)
Q
75247250002
Restated Articles of
December 31,
October 26,
Incorporation
2004
73286740001
Public Information Report
December 31,
January 30,
(PIR)
2005
115910080001
Public Information Report
December 31,
August 30,
(PIR)
2006
142416750001
Public Information Report
December 31,
October 30,
(PIR)
2007
191272250001
Public Information Report
February 5,
February 5,
(PIR)
2010
293798000002
Change of Registered
Agent/Office
Order Return to Search
2002 2003
Page 2 of 2
December 31,
October 2,
No 1
2003
2003
November 18,
November 18,
No 6
2004
2004
December 31,
October 26,
No 1
2004
2004
December 31,
January 30,
No 2
2005
2006
December 31,
August 30,
No 1
2006
2006
December 31,
October 30,
No 2
2007
2007
February 5,
February 5,
No 1
2010
2010
Instructions:
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BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY
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UCC 1 Busin.ess.._Organzations Trademarks Notary Account Help Fees Briefcase
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BUSINESS ORGANIZATIONS INQUIRY - VIEW ENTITY
Filing Number: 79317200 Entity Type: Domestic For -Profit
Corporation
Original Date of Filing: April 14, 1986 Entity Status: In existence
Formation Date: N/A
Tax ID: 17521274971 FEIN:
Duration: Perpetual
Name: Ken Hill Investment Group, Incorporated
Address: 101 JIM WRIGHT FWY S STE 200
FORT WORTH, TX 761082202 USA
REGISTERED FILING ASSUMED ASSOCIATED
AGENT HISTORY NAMES MANAGEMENT NAMES ENTITIES
Last Update
Name
Title
May 7, 2009
MICHAEL INGRAM
DIRECTOR
May 7, 2009
MICHAEL INGRAM
VICE
PRESIDENT
May 7, 2009
MICHAEL INGRAM
SECRETARY
May 7, 2009
MICHAEL INGRAM
TREASURER
May 7, 2009
May 7, 2009
May 7, 2009
KEN HILL
KEN HILL
JEFF FARRIS
Order Return to Search
DIRECTOR
CEO
PRESIDENT
Address
101 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
101 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
101 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
101 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
101 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
10 1 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
101 JIM WRIGHT FWY STE 200
FORT WORTH, TX 76108 USA
Instructions:
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This document was prepared by:
Robert L. Kline, Esq.
KLINE, MOORE & KLEIN, P.A.
2600 Douglas Road
Suite 902
Coral Gables, Florida 33134
Phone: (305) 441-0006
CFH 200?RO849036
OR PN 27095 Fss 4252 - 4254; (3vss)
RECORDED 11/25/2009 12:22:21
DEED DOC TAX 22000.00
HARVEY RUVINY CLERK OF fD1JRT
MIAMI-DADE COUNTYi FLORIDA
(The above space is reserved for recording informa0on)
WARRANTY DEED
(STATUTORY FORM -SECTION 689.02 F.S.)
THIS INDENTURE, made this U day of November, 2009, by and between ALAN
SCOTT DANSICY, a single man, whose post office address is 6431 Pine Tree Drive Circle, Miami
Beach, FL 33141 ("Grantor") and KEN HILL INVESTMENT GROUP, INC., a Texas
corporation, whose post office address is 101 Jim Wright Freeway South, Suite 200, Fort Worth,
TX 76108 ("Grantee").
WITNESSETH, that said Grantor, for and in consideration of the sum of Ten ($10.00)
Dollars, and other good and valuable considerations to said Grantor in hand paid by said Grantee,
the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said Grantee, and
Grantee's successors and assigns forever, the following described land, situate, lying and being in
Miami -Dade County, Florida, to -wit:
Lot 13, Block 1, of RESUBDIVISON OF PORTION OF
BISCAYNE ISLAND, according to the Plat thereof, as recorded
in Plat Book 40, at Page 34, of the Public Records of Miami -Dade
County, Florida.
SUBJECT TO:
1. Taxes forthe year 2010 and subsequentyears (Folio No.: 01-3232-0260100);
2. Easements, conditions, limitations, restrictions and reservations of record, if
any, without any intent to reimpose the same; and
3. Zoning and municipal ordinances;
The benefits and obligations hereunder sball inure to and be binding upon the successors and assigns
of the Grantee and the Grantor hereby covenants with said Grantee thatthe Grantor is lawfully seized
of said land in fee simple, that the Grantorhas good right and lawful authority to sell and convey said
land and said Grantor does hereby fully warrant the title to said land, and will defend the same
against the lawful claims of all persons whomsoever,
Book27095/Page4252 CFN#20090849036 Page 1 of 3
IN WITNESS WHEREOF, Grantor has hereunto set her hand and seal the day and year first
above written.
i ed, sealed d delivered
n• 1 p se e f•
Printed/typed nam of witness
MccR�c� rnati �
Printed/typed name of witness
STATE OF FLORIDA )
)ss.
COUNTY OF MIAMI-DADE )
-" � tJ✓ LS
ALAN SCOTT DANSKY
The foregoing instrument was acknowledged before me this / rZ day of November, 2009
by ALAN SCOTT DANSKY, a single man, who is personally known to me orw has produced
FlcL 0 v+ v e rs (.l c,ONS F- as identification and who did ( ) did not ( ) take an oat i.
C q1_1 �
NOTARY PUBLIC, State of Florid
r"
MWAC WWM Print Name: M4 (Lto— e •
MyC0MMI8SI0NIfgD786120 My Commission Expires:
q(PIRES, Mey 6, 20%
Book27095/Page4253 CFN#20090849036 Page 2 of 3
0
CITY OFMIAMI
p ,„,11 11,,, } 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: -David E . Sacks
irs ame (Middle) (Last Name
HOME ADDRESS: 90 Alton Road, Apt. 811
(Address Line )
(Address Line 2)
CITY: Miami Beach STATE:
Florida ZIP: 33139
HOMEPHONE: 305-673-1047 CELLPHONE: 305-968-7907 FAX:
EMAIL: dsacksCpathmanlewis.com
BUSSINESS or APPLICANT or ENTITY NAME
Pathman Lewis, LLP
BUSINESS ADDRESS: One Biscayne Tower, Suite 2400, 2 S. Biscayne Boulevard
(Address Line 1)
Miami, Florida 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.
Special Exception Permit for Construction of a Single Family Docking
Facility
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?
d 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 Acluiowledgement,
3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed. µ
Name Address Phone#
a.
b,
C.
* Additional names can be placed on a separate page attached to this form,
4. Please describe the nature of the consideration.
5. Describe what is being requested in--exchauge for the consideration.
ar
ACKNOWLEDGEMENT OF COMPLIANCE
I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of
Ordinance 1.2918 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 from any person or entity for the same issue shall be reviewed or
considered by the applicable board(s) until xpiration of a period of one year after the
nullification of the application or order.
PERSON SUBMIT'T'ING DISCLOSURE:
M gnature
S "�
Pr nt Name
/?/W21�f 2 The foregoing
nvorn to and subscribed before me this day of Q61
instrument was acknowledged before me by ,7)/) E,__ lvho has produced
as identification andlol is_ersonally kn tvn-t nae ark tivho did/did not take an oath,
�+ `IE F X777)
STAlL OF �LOlV1�A s'
CITY OF MIAMI
2
MY COIvMSSION 00 f ,
EXPIRES:11
3 Pd t ame
Enclosures) gtia�Y CANDIDA'CON E
A. MY COMMISSION # dp 9,228,;?
Doc, No.:86543 EXPIRES, November 25, 20 ;:; Page z
FFifa� nonaeu
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