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HomeMy WebLinkAboutApplication & Supporting DocsVIA HAND DELIVERY Mr. Anel Rodriguez Department of Hearing Boards City of Miami 444 SW 2°d Avenue Miami, FL 33130 Re: Public Hearing Applications Dear Mr. Rodriguez: Our firm represents Ms. Maricela Perez and Mr. Rolando Arzola (owner) and PHG Holdings, LLC, a Florida limited liability company (contract purchaser)(collectively, the "Applicants") who are the owners of the properties located at 3645 NW 21 Court and 3629 NW 21 Court, respectively, and legally described in the attached Exhibit "A" (collectively, the "Property"). The Property is designated Medium Density Restricted Commercial in the Miami Comprehensive Neighborhood Plan and is zoned T5L under Miami 21. The Property is located just east of NW 22 Avenue in the pocket bounded by NW 36 Street, the SR 112 Expressway and the Miami Jackson Senior High School campus - an area characterized by a mix of underutilized parcels, residential uses and commercial uses. The existing housing stock in the area is in a poor deteriorated condition. Notwithstanding, existing retail uses that serve the daily needs of residents including grocery stores, restaurants, schools and other daily services are within walking distance of the Property. The Property is an urban infill development site located within the Earlington Heights Station Transit Oriented Development 1/4 mile pedestrian shed as depicted in Article 4, Diagram 11 of the Miami 21 Code, copy enclosed herein. The Property is serviced by existing infrastructure including water, sewer, roads and other utilities. In addition, the Property is in WEISS SEI-,OTA HELFMAN PASTORIZA COLE & BONISKE, P.L. ATTORNEYS AT LAW MITCHELL BIER MAN, P.A. LORI ADELSON* •x:� NINA L. BONISKE, P.A. A PROFESSIONAL LIMITED LIABILITY COMPANY LILLIAN M. ARANGO MITCHELL J. BURNSTEIN, P.A. BROOKE P. DOLARA-- JAMIE ALAN COLE, P.A. INCLUDING PROFESSIONAL ASSOCIATIONS RAQUEL ELEJABARRIETA,... STEPHEN J. HELFMAN, P.A. MIAMI-DADE OFFICE CHAD S. FRIEDMAN GILBERTO PASTORIZA, P.A. OLIVER GILBERTS MICHAEL S. POPOK, P.A. 2525 PONCE DE LEON BOULEVARD R. BRIAN JOHNSON JOSEPH H. SEROTA, P.A. JOHN J. KENDRICK III �•�•' SUSAN L. TREVARTHEN, P.A. SUITE 700 HARLENE SLLVERN KEN Iy�EpY* RICHARD JAY WEISS, P.A. CORAL GABLES, FLORIDA 33134 KAREN LIEBERMAN* DAVID M. WOLPIN, P.A. JOHANNA M. LUNDGREN- KATHRYN M. MEHAFFEY TELEPHONE 305-854-0800 MATTHEW PEARL DANIEL L. ABBOTT FACSIMILE 305-854-2323 JOHN J. QUICK AARON.BEHAR AMY J. SANTIAGO GARY L. BROWN WWW.WSH-LAW.COM DANIEL A. SEIGEL IGNACIO G. DEL VALLE x GAIL D. SEROTA ALAN L. GABRIEL BROWARD OFFICE JONATHAN C. SHAMRES DOUGLAS R. GONZALES 200 EAST BROWARD BOULEVARD • SUITE 1900 ESTRELLITA S. SIBILA EDWARD G. GUEDES JONATHAN Z. KURRY - FORT LAUDERDALE, FLORIDA 3330.1 ALISON F. SMITH MATTHEW H. MANDEL TELEPHONE 954-763-4242 • FACSIMILE 954-764-7770 ANTHONY C. SOROKA ALEXANDER L. PALE NZUELA-MAORI EDUARDO M. SOTO ANTHONY L. RECIO JOANNA G. THOMSON BRETT J. SCHNEIDER SOF COUNSEL MICHELLE D. VOS CLIFFORD A. SCHULMAN PETER D. WALDMAN* LAURA K. WENDELL JAMES E. WHITE DEREK R. YOUNG September 7, 2010 VIA HAND DELIVERY Mr. Anel Rodriguez Department of Hearing Boards City of Miami 444 SW 2°d Avenue Miami, FL 33130 Re: Public Hearing Applications Dear Mr. Rodriguez: Our firm represents Ms. Maricela Perez and Mr. Rolando Arzola (owner) and PHG Holdings, LLC, a Florida limited liability company (contract purchaser)(collectively, the "Applicants") who are the owners of the properties located at 3645 NW 21 Court and 3629 NW 21 Court, respectively, and legally described in the attached Exhibit "A" (collectively, the "Property"). The Property is designated Medium Density Restricted Commercial in the Miami Comprehensive Neighborhood Plan and is zoned T5L under Miami 21. The Property is located just east of NW 22 Avenue in the pocket bounded by NW 36 Street, the SR 112 Expressway and the Miami Jackson Senior High School campus - an area characterized by a mix of underutilized parcels, residential uses and commercial uses. The existing housing stock in the area is in a poor deteriorated condition. Notwithstanding, existing retail uses that serve the daily needs of residents including grocery stores, restaurants, schools and other daily services are within walking distance of the Property. The Property is an urban infill development site located within the Earlington Heights Station Transit Oriented Development 1/4 mile pedestrian shed as depicted in Article 4, Diagram 11 of the Miami 21 Code, copy enclosed herein. The Property is serviced by existing infrastructure including water, sewer, roads and other utilities. In addition, the Property is in Mr. Anel Rodriguez September 7, 2010 Page 2 close proximity to Miami International Airport, the Miami Intermodal Center and the MIC- Earlington Heights Metrorail Extension. It's location within the Transit Oriented Development 1/4 mile pedestrian shed coupled by the various transit opportunities and daily retail services makes this Property a viable location for increased density. The Applicants are seeking an amendment to the comprehensive plan designation of the Property from Medium Density Restricted Commercial to General Commercial, consistent with the designation of the properties immediately to the south of the subject Property. In addition, the Applicants are seeking a rezoning from T5 -L to T6-8 O. The rezoning request meets the criteria set forth in Sec. 7.1.2.8(c)(1) as the request is for an extension of an existing transect boundary and the change we are seeking meets the successional zone change requirement set forth in Sec. 7.1.2.8(a)(3), be it a rezoning to the next higher transect zone. The purpose of the requests is to increase the permissible density in order to accommodate an affordable housing transit oriented development at the subject Property. Such request is consistent with the existing goals, policies and objectives of the Miami Comprehensive Neighborhood Plan as well as the goals and mandates set forth in House Bill 697 (2008), now codified in Fl. Stat. Ch. 163.3161 Local Government Comprehensive Planning and Land Development Regulation Act, which include the promotion of energy efficient land use patterns and greenhouse gas reduction strategies, transportation strategies to reduce greenhouse gas emissions, as well as energy efficiency in the design and construction of new housing. While the City has not fully amended its comprehensive plan to include the required Goals, Policies and Objectives per House Bill 697, the changes we are seeking further the express goals of the legislature and are in-line with smart growth and urban planning principles that are the essence of the Miami 21 Code. A transit oriented affordable housing development at this location would serve the best interest of the neighborhood and the community at large. Increasing density at the right location — where there is existing infrastructure, mixed -uses, access to multiple modes of transportation, and the opportunity to increase transit ridership — increases the viability of a community as well as the area businesses. Increased transit ridership provides energy and vehicle mile trip savings and, even more importantly in these times of tight budgets, results in greater allocations of Federal transportation funding to the state, county and local government. The increased density will also provide the Applicants the opportunity to fully compete for state credit financing dollars as the funding guidelines have been amended by the state to fully encourage the development of transit oriented developments which incorporate sustainable design elements. Finally, due to the unique characteristics of the existing area, its location within a Transit Oriented Development 1/4 mile pedestrian shed and the revitalization of the general area as a multi -modal transportation hub indicate that the current comprehensive plan and zoning designation are inappropriate for the existing area and result in an inefficient use of land, inefficient use of existing infrastructure and does not meet the intent of the Miami 21 Code. The WEISS SE -ROTA HELFMAN PASTORIZA COLE & BONISKE, P.L. Mr. Anel Rodriguez September 7, 2010 Page 3 General Commercial and T6-80 designations for this Property is in-line with the intent of the Miami 21 code as well as smart growth principles, sustainable development guidelines and transit orientated development initiatives that Miami 21 incorporates. The Miami 21 Code is intended to advance the interests of both conservation and development while responding to the existing conditions of the City, its regional context, and its natural features, infrastructure and Buildings. The changes we seek undeniably further the intent and purpose of the Miami 21 Code. Please refer to the enclosed map series depicting the properties within 0.5 miles of the Property including aerial, Future Land Use Plan map and Miami 21 Zoning Atlas. For the reasons stated herein, we believe that the comprehensive plan and zoning change is justified and we kindly request your favorable recommendation and approval of this request. Thank you for your consideration of this matter. Please call me if you have any questions or require additional information. GP/ms 676049 V Gilberto Pastoriza WEISS SEROTA HELFMAN PASTORIZA COLE & BONISKE, P.L. Exhibit "A" Legal Description The South I/z of Lot 5 and Lot 6 of Block 2 of "BECKER'S SUBDIVSION," according to the Plat thereof, as recorded in Plat Book 16 at Page 43 of the Public Records of Miami - Dade County, Florida. Lot 4 and the North'/2 of Lot 5 of Block 2 of "BECKER'S SUBDIVSION," according to the Plat thereof, as recorded in Plat Book 16 at Page 43 of the Public Records of Miami - Dade County, Florida. Mr. Anel Rodriguez September 7, 2010 Page S Future Land Use Map Properties within 0.5 miles Mr. Anel Rodriguez September 7, 2010 Page 6 Miami 21 Zoning Atlas Properties within 0.5 miles N NtT wy. 4GGl £rl MN a5lh St . NNY_44G.St - tSV443rd St N1Y 424d -St • NYf 420 St - � Z IlH;aa:- Faft.ngtgn - -.- NYf 41*1. St Mr. Anel Rodriguez September 7, 2010 Page 7 Miami Intermodal Center Map Superintendent of Schools Alberto M. Carvalho September 24, 2010 VIA ELECTRONIC MAIL Mr. Gil Pastoriza c/o Ms. Maricela Perez 3629-3645 NW 21 Court Miami, Florida RE: PRELIMINARY SCHOOL CONCURRENCY ANALYSIS (SCHOOLS PLANNING LEVEL REVIEW) MARIELA PEREZ AND ROLANDO ARZOLA LOCATED AT 3645. NW 21 COURT PH0110091700325 — Folio No. 0131220360121 Dear Mr. Pastoriza: Miam!-Dade Coutify School Board Dr, Solomon C. Stinson, Chair Perla Tabares Hantman. Vice Chair Agustin J. Barrere Renier Diaz de la Portilla Dr. Lawrence S. Feldman Dr. Wilberi "Tee" Holloway Dr. Martin Stewart Karp Ana Rivas Logan Dr, Marta Perez Pursuant to State Statutes and the Interlocal Agreements for Public School Facility Planning in Miami - Dade County, the above -referenced application was reviewed for compliance with Public School Concurrency. Accordingly, attached please find the School District's Preliminary Concurrency Analysis (Schools Planning Level Review). As noted in the Preliminary Concurrency Analysis (Schools Planning Level Review), the requested zoning would yield a maximum residential density of 53 multifamily units and 4 single-family attached units, which generates 14 students; 7 elementary, 3 middle and 4 senior high students. At this time, the schools serving the area have sufficient capacity available to serve the application. However, a final determination of Public School Concurrency and capacity reservation will only be made at the time of approval of final plat, site plan or functional equivalent. As such, this analysis does not constitute a Public School Concurrency approval. Should you have any questions, please feel free to contact me at 305-995-4501. Sinc y, an M. odriguez, R A. Director II IMR:mo L137 cc: Ms. Ana Rijo-Conde, AICP Mr. Fernando Albuerne Ms. Vivian G. Villaamil City of Miami School Concurrency Master File Department of Planning, Design and Sustainability Ana Rio -Conde, AICP, Eco -Sustainability Officer • 9450 N.E. 2 Ave. e Suite 525 o Miami, FL 33932 305-995-7285 • (FAX) - 305-995-4760 • arijo@dade schools, net conturrancy m arenoorue"t System (CMS) Miami Dade County Public schools Miami -Dade County Public Schools Concurrency Management System Preliminary Concurrency Analysis MDCPS Application Number: PHO110091700325 Local Government (LG): Miami Date Application Received: 9/17/2010 3:43:38 PM LG Application Number: 10-01095lu Type of Application: Public Hearing Sub Type: Land Use Applicant's Name: Mariela. Perez & Rolando Arzola c/o_Gil Pastoriza Address/ Location: 3629-3645 NW 21 Court Master Folio Number: 0131220360121 Additional Folio Number(s): 0131220360130, PROPOSED # OF UNITS 57 SINGLE-FAMILY DETACHED UNITS: 0 SINGLE-FAMILY ATTACHED UNITS. MULTIFAMILY UNITS: 53 CONCURRENCY SERVICE AREA SCHOOLS CSA Facility Name Net Available Seats Seats LOS Source Id Capacity Required Taken Met Type 111 MAYA ANGELOU 45 7 7 YES Current CSA ELEMENTARY 6011 ALLAPATTAH MIDDLE 419 3 3 YES Current CSA 7341 MIAMI JACKSON SENIOR 854 4 4 YES Current CSA HIGH ADJACENT SERVICE AREA SCHOOLS *An Impact reduction of 14,01% included for charter and magnet schools (Schools of Choice). MDCPS has conducted a preliminary public school concurrency review of this application; please see results above. A final determination of public school concurrency and capacity reservation will be made at the time of approval of plat, site plan or functional equivalent. THIS ANALYSIS DOES NOT CONSTITUTE PUBLIC SCHOOL CONCURRENCY APPROVAL.. 1450 NE 2 Avenue, Room 525, Miami, Florida 33132 / 305-995-7634 / 305-995-4760 fax / concurrency@dadeschools.net Applicant Fields Information Application Type Application Sub -Type Application Name Perezi Application Phone * 2.00 Application Email *L, Fattwi A Application Address 'NoDA-3i[Azi WW 2,A Contact Fields Information Contact Name * 9asbrilizA Contact Phone * 05 -d 0 Contact Email P St- r 'z.a % Local Govt. Name City of Miami Local Govt. Phone 305-416-1400 Local Govt. Email GDGaya,ci.miami.fl.Lis Local Govt. App. Number (OFFICIAL USE ONLY) Property Fields Information Master Folio Number Additional Folio Number 2Z ^O ,. Total Acreage Proposed Land Use/Zoning 0 Single -Family Detached Units Single -Family Attached Units (Duplex) Multi -Family Units Total # of Units Redevelopment Information (MUSPs) • Re -development applications are for those vacant sites for which a local government has provided vested rights; or for an already improved property which does not have to be re -platted as deemed by the local government. The number of units to be input into the CMS is the net difference between the existing vested number of units and the newly proposed number of units. Example: an existing 20 -unit structure will be torn down for redevelopment. The newly proposed development calls for40 total units. Local government shall input 20 units in the CMS (net difference between the 20 units vested less the newly proposed 4 units). Required Fields for Application C21'l6ex-fa NSfi67 Owner(s /Attorney/Applicant Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Owner(s)/Attorney/Applicant Signature Tl, ig_foreg �ng w a� yowled ed b e me its 20 day of ��� Y who is a(n) individnal/partner/agent/corporation of — n individual/partnership/corpora yon. He/She is personally known to me or who has produced as identification and who did (did not) take an oath. , ` . /r Aa t -/b U;I Fast; riZa rm (Stamp) 1pRY Pua Siggn�ature " mHHILYN SOMOghV11 L; �o .««•«, ��o MARILYN 8®MI�Dl��l� * MY COMMISSION # DD 70491, « MY COMMISSION #0070 , Baa EXPIRES: September 13, ?01 v� EXPJ r ��r y�yp For.F B"d"d Th" 840t Notary 5�•, ®RNdllidllljilCUl�il6�l�p'S`�GIYPF City of Miami _E Public School Concurrent ,,,,,,z,,,, < Concurrency Management System Entered Requirements Applicant Fields Information Application Type Application Sub -Type Application Name Perezi Application Phone * 2.00 Application Email *L, Fattwi A Application Address 'NoDA-3i[Azi WW 2,A Contact Fields Information Contact Name * 9asbrilizA Contact Phone * 05 -d 0 Contact Email P St- r 'z.a % Local Govt. Name City of Miami Local Govt. Phone 305-416-1400 Local Govt. Email GDGaya,ci.miami.fl.Lis Local Govt. App. Number (OFFICIAL USE ONLY) Property Fields Information Master Folio Number Additional Folio Number 2Z ^O ,. Total Acreage Proposed Land Use/Zoning 0 Single -Family Detached Units Single -Family Attached Units (Duplex) Multi -Family Units Total # of Units Redevelopment Information (MUSPs) • Re -development applications are for those vacant sites for which a local government has provided vested rights; or for an already improved property which does not have to be re -platted as deemed by the local government. The number of units to be input into the CMS is the net difference between the existing vested number of units and the newly proposed number of units. Example: an existing 20 -unit structure will be torn down for redevelopment. The newly proposed development calls for40 total units. Local government shall input 20 units in the CMS (net difference between the 20 units vested less the newly proposed 4 units). Required Fields for Application C21'l6ex-fa NSfi67 Owner(s /Attorney/Applicant Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Owner(s)/Attorney/Applicant Signature Tl, ig_foreg �ng w a� yowled ed b e me its 20 day of ��� Y who is a(n) individnal/partner/agent/corporation of — n individual/partnership/corpora yon. He/She is personally known to me or who has produced as identification and who did (did not) take an oath. , ` . /r Aa t -/b U;I Fast; riZa rm (Stamp) 1pRY Pua Siggn�ature " mHHILYN SOMOghV11 L; �o .««•«, ��o MARILYN 8®MI�Dl��l� * MY COMMISSION # DD 70491, « MY COMMISSION #0070 , Baa EXPIRES: September 13, ?01 v� EXPJ r ��r y�yp For.F B"d"d Th" 840t Notary 5�•, ®RNdllidllljilCUl�il6�l�p'S`�GIYPF HEARING BOARDS 444 SW 2nd Avenue, 7t" Floor a Miami, Florida 33130 Telephone 305-416-2030 + Fax 305-416-2035 www.miamigov.com/hearing boards Planning Designee Initial & Date AMENDMENT TO THE MIAMI COMPREHENSIVE NEIGHBORHOOD PLAN FUTURE LAND USE MAP 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 pm, except on the fifth dav, at 12:00 pm. 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 no application shall be deemed to have been filed unless and until the application is deemed 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. 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. 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. Applications for Zoning Change (Amendment to Zoning Atlas and/or Overlay District) and Land Use Change (Amend the Comprehensive Neighborhood Plan) will not be accepted unless it is signed or initialed and dated by the Planning Department designee. 1 of 3 Rev. 8-31-10 k Please refer to Section 62-32 of the Miami City Code for Comprehensive Plan information. 1. Applicant name(s): Maricela Perez and Rolando Arzola (owners) and PHG Holdings, LLC (contract purchaser) 2. Subject property address(es) and folio number(s): 3645 NW 21 Court (01-3122-036-0121); 3629 NW 21 Court (01-3122-036-0130) 3. Current designation: Medium Density Restricted Commercial 4. Future designation: General Commercial 5. Has the designation of this property been changed in the last year? If so, when? NO 6. Do you own any other property within 200 feet of the subject property? NO If yes, has the property been granted a Land Use Change within the last year? 7. Obtain signature or initial and date by the Planning Department designee prior to submittal. 8. Two (2) 11x17" original and one (1) 8'/z 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. 9. The subject property(ies) cannot have any open code enforcement/lien violations. 10. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable. 11. At least two photographs showing the entire property showing land and improvements. 12. 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. 13. 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. 14. Original Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold Objection Affidavit. 15. Original Public School Concurrency Management System Entered Requirements form (page 4 of the attached packet). 16. Certified list of owners of real estate within 500 feet of the subject property (see pages 7 and 8). 17. 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 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. 18. What is the acreage of the project/property site? If the property is greater than ten (10) acres please contact the Planning Department on the 3rd Floor for further instructions. 0.38 acres 2 of 3 Rev. 8-31-10 19. What is the purpose of this application/nature of proposed use? Amendment to the Comprehensive Plan in connection with an Affordable Housing transit oriented development. 20. 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 21. Is the property within the boundaries of an Environmental Preservation District? Please contact the Planning Department on the 3rd Floor for information. NO 22. Is the property within the Coastal High Hazard Area (CHHA)? Please contact the Planning Department on the 3rd Floor for information and further instructions. NO 23. Cost of processing according to Section 62-156 of the Miami City Code*: Application to Amend the Comprehensive Neighborhood Plan to: a. Conservation, Recreation, Residential Single Family, Residential Duplex $ 300.00 b. Residential Medium Density Multifamily $ 450.00 c. Residential High Density Multifamily, Office, Major Public Facilities, Transportation/Utilities $ 550.00 d. Commercial/Restricted, Commercial/General and Industrial $ 650.00 e. Central Business District (CBD) $ 1,200.00 f. Surcharge for advertising each item $ 1,200.00 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 paid in the form of-a-ce—rtd chi{-cazM-/e-r`s, check, or money order. Signa Name Address 2525 Ponce de Leon Blvd. #770 Coral Gables, FL 33134 Telephone (305)854-0800 E-mail gpastorizaawsh-law.com STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this day of�+`-'�, 2010, by Gilberto Pastoriza, Esq., who is a(n) individual/partner/agent/corporation of Maricela Perez. Rolando Arzola. individuals and PHG Holdinas. LLC. a Florida limited liabilitv company. He/She is,peerrsonally known to me or who has produced as identification and who dl did not) take an oath. /) n (Stamp) Sigr, M. rqc WIARILYNSOMODEVILLA * MY COMMISSION 4 DD 704986 EXPIRES, Sapiomber 13, 2011 ,""OF F��Wed Thru 8uuyer Notary Servlr•� 3 of 3 Rev. 8-31-10 REZONING",4PPLICATION AFF-IDA'V1T OF AUTHORITY TO ACT Before me this day, the undersigrtecl personally appeared Maricela Perez, who being by me first deposes and says: 1. That she is the 0*ner, 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 Gilberto Rastoriza; Tony Recio;-and Estrellita Sibila of Weiss Serota Helfman, Pastoriza Cole & Boniske are authorized, directed and -empowered to execute any and all applications, affidavits, disclosures of interest, petitions, -etc.; and to act in his behalf for the change or modification of a classification or regulation of zoiiing'as set out in the foregoing petition, 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. Maricela Perez ��1G�✓ Applicant(s) Name Applicant(s) Signature STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this ;,7 & day of 0I UC% 2010, by Maricela Perez, an individual. He/She isomer— sona(ly n�I—c own�fo m of who has produced as identification and who did (did not) take an oath. (Stamp) .........YEL'NA 1. GONZ®®�®e•6 ALEZ , y wa,,Ig � comm# DD0t354322 Expires 1/2512013 Florida Notary Assn., Inc 14a......ee...e.n.....e.......................® Revised May 2010 Signature CITY OF MIAMI H E A R I N G B O A R D S Ph: 305-416-2030 444 SW 2„d Ave 71h floor Miami, FL 33130 www.miamigov.com/hcaring—boards REZONING APPLICATION AFFIDAVIT OF AUTHORITY TO ACT Before'me'this day; the undersigned personally appeared Rolando Arzola, who being by me first deposes and says; 5..That he is 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. 6. That all owners Who he/she represents, if any, have given his/her full and complete permission for Gilberto Pastoriza, Tony Recio, and Estrellita Sibila of Weiss Serota Helfman, Pastoriza Cole & Boniske are authorized, directed and empowered to execute any and all applications, affidavits, disclosures of interest, petitions, etc., and to act in his behalf for the change or modification of a classification or regulation of zoning as set out in the foregoing petition, including responses to day to day staff inquires. 7. 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. 8. That the facts, as represented in the application and documents submitted in conjunction with this affidavit, are true and correct. Further Affiant sayeth not. Rolando Arzola Applicant(s) Name STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this 2& day of &)q CJS .� 2010, by Rolando Arzola, an individual. He/She is Koe`e`Fs"—n IIS -known oe3or who has produced as identification and who did (did not) take an oath. (Stamp).%gBeeeeBWYELINA1. GOWALEZ.a®�e��® Comm# DDO854322 Expires 112512013 Florida Notary Assn., Ina . We■aesa®eeeuaeeosouueeeeeeueeueeeueeeee0 Revised May 2010 Signature CITY OF MIAMI H E A R I N G B O A R D S Ph: 305-416-2030 444 SW 2nd Ave Th Floor Miami, FL 33130 www.miamigov.com/hearing_boards REZONING."A'-PPLICATION D,ISQtQSURE OF OWNERSHIP 3 List `the owlet(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 otherinterested parties, together with their address(es) and proportionate interest are required.' Please supply additional lists, if necessary. Owner's Name(es) Rolando Arzola Percentage of Ownership 100% Subject Prope�y Address(es) 3629 NW 21 Court 4. 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): n/a Rolando Arzola Applicant Name Legal Description(s): 61e1J1►I V&el0JTJI/_1kileJ_1» The foregoing was acknowledged before me this day of AiUi 2010, by Rolando Arzola who is a(n) individual. He/She i personally nowt me or who has produced as identification and who did (did not) take an oath. (A_)� (Stamp) Signature §e Peaeea Peeaaao PBPeeeae ne00PePP6e48P0F18000BO6U` YELINA I. GONZALEZ Comm# DD0854322 Expires 1/25/2013 9 Florida Notary Assn., Inc I PoeauePeeeeu eeaPUPueeouueuuaoeoeeeuee� CITY OF MIAMI H E A R I N G B O A R D S Ph: 305-416-2030 444 SW 2,d Ave 71h Floor Miami, 11., 33130 Revised May 2010 www.miamigov.com/hearing_boards R,EZQN I N 0 APPLICATION 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) Maricela Perez Percentage of Ownership_ Subject Property Address(es) 3645 NW 21 Court 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): Maricela Perez Applicant Name Legal Description(s): 100 Applicant Signature STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this a269 day of fic)QUr, T 2010, by Maricela Perez a(n) individual. He/She i personally known t � or who has as identification and who did (did not) take an oath. (Stamp) Signature 3..... .....8i ................... YELINA 1. GONZALEZ Comm# DD0854322 e Expires 1/25/2013 Flodda Notary Assn., Inc a mr - ��aaae eeaaaeenaeea. CITY OF MIAMI H E A R I N G B O A R D S Ph: 305-416-2030 444 SW 21d Ave Th Floor Miami, FL 33130 Revised May 2010 www.miamigov.com/hearing_boards produced 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 applicable. Contract Purchaser Name PHG Holdings, LLC Percentage of Ownership Contract Purchaser Subject Property Address(es) David Deutch 25% Louis Wolfson 25% NIA Mitchell Friedman 25% Michael Wohl 25% 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): NIA David Deutch PHG Holdings, LLC Legal Description(s). r Signature STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this Sy day of 2010, by David Deutch, as Vice President of PHG Holdings, LLC, a Flo da limited liability company. She is personal) kn or who has produced as identification and who did (did not) take an oath. �wP� (Stamp) Sign at le ��1"`���cq`°'>�r,, GpEgi14SSIDNe�o e (D^',� Rev. 12-16-08 Lemberg m �eQ c'o 9y,P X0!)519259 a -� n srnT J� J!?l2B143l43�� State of Florida Department of State I certify from the records of this office that PHG HOLDINGS, LLC is a limited liability company organized under the laws of the State of Florida, filed on July 14, 2005. The document number of this limited liability company is L05000069398. I further certify that said limited liability company has paid all fees due this office through December 31, 2010, that its most recent annual report was filed on February 25, 2010, and its status is active. I further certify that said limited liability company has not filed Articles of Dissolution. Given under my hand and the Great Seal of Florida, at Tallahassee, the Capital, this the Thirtieth day of August, 2010 Secretary of State * Authentication ID: 200184878412-083010-L05000069398 f+Q2}ny To authenticate this certificate,visit the following site, enter this ID, and then follow the instructions displayed. https:Heflle.sunbiz.org/certauthver.html Property Information Map Property Information Map http: //gis ims2.miamidade.gov/myhome/printmap. asp?mapurl=http: //gis... My Home Miami -Dade County, Florida Aerial Photography - 2009 0 112 ft This map was created on 8/23/2010 10:46:23 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. s- MIAMIDADE Summary Details: Folio No.: 16 1-3122-036-0121 Property: 0645 NW 21 CT Mailing RICELA PEREZ Address: r645 Exemption/ NW21CT MIAMI FL Beds/Baths: 42- Property Information: Assessment Information: Year: 3 3900 MULTI -FAMILY, Primary Zone: MEDIUM DENSITY Building Value: Market Value: RESIDENTIAL CLUC: 0001 RESIDENTIAL - Exemption/ SINGLE FAMILY Beds/Baths: 2/1 Floors: 11 Living Units: 1 dj Sq Footage: 11,298 Lot Size: 18,320 SQ FT Year Built: 11926 $0/$76,211 BECKERS SUB PB 16-43 School Board: LOT 4 & N1/2 OF LOT 5 Legal BLK 2 LOT SIZE 8320 Description: SQUARE FEET COC 4294-251902 2006 4 OR 27139-0969 1209 01 Assessment Information: Year: 1 2010 2009 Land Value: F $33,280 $62,400 Building Value: Market Value: 1 $42,931 $94,430 F $76,211 $156,830 Assessed Value: $76,211 $156,830 Taxable Value Information: Year: 1 2010 2009 Sale O/R: Applied Applied axing Authority: Exemption/ Exemption/ Description: Taxable Taxable Value: Value: Regional: 1 $0/$76,211 $0/$156,830 County: $0/$76,211 $0/$156,830 City: $0/$76,211 $0/$156,830 School Board: $0/$76,211 $0/$156,830 Sale Information: Sale Date: 12/2009 Sale Amount: 70,000 Sale O/R: _ 27139-0969 Sales Sales qualified as a result Qualification f examination of the deed Description: View Additional Sales 1 of 1 8/23/2010 10:46 AM Property Information Map Property Information Map http://gisims2.rniamidade.gov/myhome/printmap.asp?mapurl=http: //gis... My Home Miami -Dade County, Florida Aerial Photography - 2009 0 - 112 ft This map was created on 8/23/2010 10:45:07 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. a Close`, 1 of 1 MIAMI -CAG E Summary Details: Folio No.: 01-3122-036-0130 Property: 13629 NW 21 CT Mailing ROLANDO ARZOLA Address: 0001 RESIDENTIAL - Market Value: 3629 21 ST CT MIAMI FL Beds/Baths: 33142 - Property Information: Assessment Information: Year: 3900 MULTI -FAMILY, Primary Zone: MEDIUM DENSITY $61,500 RESIDENTIAL CLUC: 0001 RESIDENTIAL - Market Value: SINGLE FAMILY Beds/Baths: 2/1 Floors: 11 Living Units: 11 Adi Sq Footage; 11,220 Lot Size: 18,200 SQ FT Year Built: 11926 BECKERS SUB PB 16-43 School Board: S1/2 LOT 5 & ALL LOT 6 Legal BLK 2 LOT SIZE 8200 Description: SQUARE FEET COC 24294-2521 02 2006 4 OR 27224-4050 0310 01 Assessment Information: Year: 2010 2009 Land Value: $32,800 $61,500 Building Value: $42,580 $92,239 Market Value: $75,380 $153,739 Assessed Value: $75,380 $153,739 Taxable Value Information: Year: 2010 2009 Sale O/R: Applied Applied Taxing Authority: Exemption/ Exemption/ Description: Taxable Taxable Value: Value: Regional: $0/$75,380 $0/$153,739 County: $0/$75,380 $0/$153,739 City:$01$75,380 $0/$153,739 School Board: $0/$75,380 $0/$153,739 Sale Information: Sale Date: 3/2010-� Sale Amount: $71,500 Sale O/R: 27224-4050 Sales _ Sales qualified as a result Qualification of examination of the deed Description: View Additional Sales 8/23/2010 10:45 AM CERTIFIED COMPANY RESOLUTION The undersigned hereby certifies that M iaJ1 is a Manager/Member of PHG Holdings, LLC, a Florida limited liability company (the "Company"), that the following is a true and correct copy of the resolutions adopted by the its members at a meeting held on ,Ajjqoj IC? , at the offices of the Company. RESOLVED by the members of this Company that the Company consents to and joins in the filing with the City of Miami all applications for zoning approvals for the property located at 3629-3645 NW 21 Court 3629 NW 21 Court; FURTHER RESOLVED, that the Company authorizes Gilberto Pastoriza, Esq., Tony Recio, Esq. and Estrellita Sibila, Esq. of the law firm of Weiss Serota Helfman Pastoriza Cole & Boniske, P.L. to act on its behalf and execute and deliver any and all applications, petitions and other documents pertaining to the applications for zoning approval, and to take any and all such actions consistent with obtaining approval of said applications that may be deemed necessary by the Company. The adoption of said resolutions was in all aspects legal; and that said resolutions are in full force and effect and have not been modified or rescinded. Dated this Z day of leu uj , 2010. PH�Holdings, LLC a Florida limited liability company By: j o� State of Florida County of Miami -Dade I HEREBY CERTIFY THAT on this day, before me, an officer duly qualified to take acknowledgments, personally appeared j � ,w 0� , as Managing Member of PHG Holdings, LLC, a Florida Limited Liability Company, to me personally known [ ] or produced identification in the form of , and who executed the foregoing resolution and acknowledged before me that he executed the same for the purposes herein expressed. WITNESS my hand and seal in the county and state last aforesaid, this J1 day of 12010. NORMA A. TORRES ' = MY COMMISSION # DD 794849 F;�-- EXPIRES; June 22, 2012 Thru Notary Publio Underwriters Exhibit "A" LeIzal Description The South %2 of Lot 5 and Lot 6 of Block 2 of "BECKER'S SUBDIVSION," according to the Plat thereof, as recorded in Plat Book 16 at Page 43 of the Public Records of Miami - Dade County, Florida. AND Lot 4 and the North 11/2 of Lot 5 of Block 2 of "BECKER'S SUBDIVSION," according to the Plat thereof, as recorded in Plat Book 16 at Page 43 of the Public Records of Miami - Dade County, Florida. THIS INSTRUMENT PREPARED BY AND RETURN TO: Kety Gandam The Marlen Rodriguez Title Group 6175 NW 153 Shat #102 Miami takes, FL 33014 Property Appraisers Parcel Identification (Folio) Number: 01-3122.0364121 LAilfl sill! 11111 i1f111lI1i11111 Alli fllf Iltl CFhI 2010R0005779 OR 'Bk 27139 Fss 0969 - 9701 (2p9s) RECORDED 01/06/2010 08.,46:47 DEED DOC TAX 420,00 HARVEY RUVINY CLEFT; OF COURT MIAMI-DADE COUHTYr FLORIDA ABOVE THIS LINE FOR RECORDING DATA WAIMNT Y DEED THIS WARRANTY DEED, made the 30th day of December, 2009 by Rodolfo Corujo, a single .man, whose post office address is 10008 West Fingler Street #287, Miami, FL 33174 herein called the Grantor, to Maricela Perez, a married woman whose post office address is 3645 NW 21 Court, Miami, FL 33142, hereinafter called the Grantee: (Wherever used herein the terms "Grantor" and "Grantee" Include all the parties to this Instrument and the heirs, legal representatives and assigns ofindividuals, and the successors and assigns of corporations) W I T N E S S E T H: That the Grantor, for and in consideration of the sum of TEN AND 00/100'S ($10.00) Dollars and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and conflmis unto the Grantee all that certain land situate in MIAMI-DADE County, State of Florida, viz.: SEE EXHIBIT A Subject to easements, restrictions and reservations of record and taxes for the year 2009 and thereafter. TOGETHER, with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD, the same in fee simple forever. AND, the Grantor hereby covenants with said Grantee that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and lawful authority to sell and convey said land, and hereby warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2009 IN WITNESS WHEREOF, the said Grantor has Signed and sealed these nresenfs the day and vear first ahnve. written. and delivered in the presence of: Witness #2 Signature Witness #2 Printed Name ' STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged beforea this 30th day of December, 2009 by Rodolfo Conijo who is personally known to me or has produced VOL as identification, SEAL KE'rYGANDARA Netsr tbli rp, +° h: Notary Public . Slate of Fbrida �9• : `;Aly Cornet ssfon Expires Jul 4, 2010 Po CeMMIS9len # D0 570888 Printed No ary Name My Commission Expire r„1 ' Bonded By National Notary Assn. File No.: 09-220 Book27139/Page969 CFN#20100005779 Page 1 of 2 OR BK 27139 PG 0970 I—AST PAGE Exhibit "A" Legal Description for File No.: 09-220 Lot 4 artd the Norah % of IO 5, in Bicck 2, of B.ECKM,s WB>3rvmoN, according to the Flat ihomt, as rcwzdcd in Flat Book 16, at page 43, of dw Publio Pwords afMiard i3ade Couttty, Florida (which plat hm been mvokxA) awa The West 114 feet of the North 73 feat of the South 12I.0 feat ofthe But 264 feat of the So. 'Jr sof the Soust th 'la ofdw Soudmut K of Seetion 22, Towwhip S3 South, Rmge 41 East, lying behtg in Miami -!Dade Camty,. Flo Lids. Book27139/Page970 CFN#20100005779 Page 2 of 2 I IIIlI! 111!1 IIIA !1111 fllll 11111 VIII 1111 Itll OR Ek 27224 Ps 4050; (Ips) RECORDED 03/24/2010 08:30:42 THIS NSTRUMENT PREPARED BY AND RETURN TO: DEED DOC TAX 429.00 KetyGandara HARVEY RUVINr CLERK OF COURT The Marlen Rodriguez Title Group MIAMI—DADE COUNTYr FLORIDA 6175 NW 153 Street#102 LAST PAGE Miami Lakes, FL 33014 Property Appraisers Parcel Identification (Folio) Number: 01-3122.036-0130 SPACE ABOVE THIS LINE FOR RECORDING DA WARRANTY DEED THIS WARRANTY DFF,n, mad the 12th day of March, 2010 by Rodolfo Corujo, a single man, whose post office address is 1(X108 (J. Read 5t 4.& mi1.7 3311q herein called the Grantor, to Rolando Arzola, a single man whose post office address is 3629 21 St CT, Miami, FL 33142, hereinafter called the Grantee: (Wherever used herein the terms "Grantor" and "Grantee" include all the parties to this instrument and the heirs, legal representatives and assigns ofindividuals, and (lie successors and assigns of corporations) W I T N E S S E T H: That the Grantor, for and in consideration of the sum of TEN AND 00/100'5 ($10.00) Dollars and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the Grantee all that certain land situate in MIAMI-DADE County, State of Florida, viz.: The South 1/2 of Lot 5 and all of Lot 6, In Block 2, of BECKER SUBDIVISION according to the Plat thereof, as Recorded in Plat Book 16, at Page 43, of the Public Records of MIAMI-DADE County Florida. Subject to easements, restrictions and reservations of record and taxes for the year 2009 and thereafter, TOGETHER, with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD, the same in fee simple forever AND, the Grantor hereby covenants with said Grantee that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and lawful authority to sell and convey said land, and hereby warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said lurid is free of all encumbrances, except taxes scenting subsequent to December 31, 2009. IN WITNESS WHEREOF, the said Grantor has signed and sealed these presents the day and year first above written. 7 and delivered in the presence of Witness Witness #2BBnSignatur I lmd Witness #2 Printed Name STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before ne this 12th day of March, 2010 by Rodolfo Corujo who is personally known to me or has produced F/L as identification. SE KETY GAN�DARA wV ow , Notabl / ^n =o`� �,: Notary PubM • Stat0 of Fhtlds Notary tj tic M ?. My Carnldssion S:cpires Jul 4, 2010 Commission # DD 570888 My Commiss `fi0 m' Bonded By National Notary Assn. Printed Notary Name File No.: 10.017 Book27224/Page4050 CFN#20100195494 Page 1 of 1 CITY OFMIAAH 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: RA S�&y )-Z � (First Name) (Middle) (Last Name) HOME ADDRESS: Weiss Serota Helfman Pastoriza Cole & Boniske P.L. (Address Line 1 2525 Ponce de Leon 131vd., Suite 700 Address Line CITY: Coral Gables HOMEPHONE: (305)854"0000 STATE: . Florida CELL PHONE: ZIP: 33134 FAX:(305)854-2323 EMAIL: �, �Q� i I�l l""" W� '" Vy • J�i/V \ BUSSINESS or APPLICANT or ENTITY NAME 6)(1 VI( a P -WP -L -1 Cilc��c�a �z Ion BUSINESS ADDRESS: (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. 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 XN 0 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. I� 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. ) M 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 exchange for the consideration. V�1 ACKNOWLEDGEMENT OF COMPLIANCE I hereby aelmowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of Ordinance 12915 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. ccur: 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 issu hall a ewed or considered by the applicable board(s) u 1- p tion period one yea aft he nullification of the application or orde PERSON SUBMITTING DISCLOSURE: �a�1-�,�►zp Print NaMe Si -norm. to and subscribed before me this f aY of 20� L V . The foregoing instrument was a6knowledged before me by who has produced as identification and/or is personally known o m . and who didddid not take an oath. STATE OF FLORIDA CITY OF MIAMI MY COMMISSION, °,• ..Bl�n MARIL ODEVILLA EXPIRES: s * MY COMMISSION # DD 70498E L.Ar1nr8RhPteNbWf8, 2011 'Enclosure(s) OFFIOR\OP Boaded AN Budget Notary SServlp PA