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SELLER'S AFFIDAVIT
(Individual)
CONFLICT OF INTEREST AND NON -COLLUSION
STATE OF FLORIDA )
) SS:
COUNTY OF DADE )
BEFORE ME, the undersigned authority, personally appeared,
being by me first duly sworn, on oaths says:
1. I am the owner of the property located at II-t-3 C, k)W_
Miami, Florida, legally described as follows:
Ls*', 3tck
t7c..o�-t $oaYZ- r � f �
4
(the "Property").
2. I entered into a Purchase and Sale Agreement with the City of Miami (the "City")
dated �c cy.rJ�t` t 9 , pursuant to which I agreed to sell to the City
the Property (the "Agreement").
3. I have received and reviewed Chapter 2, Article V of the City of Miami Code,
Section 2-11-1, of the Miami -Dade County Code and Chapter 112, Florida
Statutes regarding conflict of interest laws and hereby certify that I am in
compliance in all respects with said laws.
4. I have not directly, or indirectly, employed or retained any person employed by the
City to solicit or secure the Agreement nor have I directly, or indirectly, offered to
pay, paid, or agreed to pay any person employed by the City any fee, commission
percentage, brokerage fee, bribe, kickback, or gift to secure the Agreement or to
sell the Property.
5. There is no person under my employ who exercises any functions or
responsibilities in connection with purchase and sale of the Property that has any
personal financial interest, direct or indirect, in the Agreement, except for my
interest, as Seller, in the sale of the Property.
6. All financial transactions occurring under the Agreement will be properly and
accurately recorded in the appropriate books of account and there will be no "off
the books" transactions or secret accounts.
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7. This Affidavit is made pursuant to the Agreement, for the purpose of inducing the
Purchaser to purchase the Property.
FURTHER AFFIANT SAYETH NAUGHT.
SWORN TO AND
--c , 1 oo:>- by
to me or who has produced
did/did not take an oath.
Sign re of Affiant
SUBSCRIBED before me this g' day of
3 1 o „,,who is personally known
as identification and who
F1 . rw . Iz
Signature olRotary
Print Name of Stamp of Notary
My Commission Expires:
2
av:Contllict of Interest Affidavit Individual.doc
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THE CITY OF MIAMI
PUBLIC DISCLOSURE AFFIDAVIT
PROJECT. Model City Home Ownership
THE CITY OF MIAMI
PARCEL NO.
FOLIO NO. o t 'S 11 c)3;-f 5.2v
The undersigned authority affirms that he/she is:
O (a) President (or Vice Presidelnt) of
Corporation authorized to do business under the laws of
Florida; or
O (b) A Partner (or Limited Partner) of the firm of
composed of and , doing •
business under the name of ; or
❑ (c) Trustee of Trust; or,
• (d) Other W - a r.w.""r S
holding title to real property described in Exhibit "A" attached hereto (the'Property") and by this
reference made a part hereof hereby certify that the names and addresses listed on Exhibit "B"
attached hereto and by this reference made a part hereof are the names and addresses of every
person having a beneficial interest in the Property, however small or minimal, and do hereby file
this affidavit for the purpose of complying with the provisions of Section 286.23, Florida
Statutes, Public Disclosure.
Affiant'S ature
/Mato %eniJzks SE&rPR r/?4,u1u5
Print of type name of Affiant
Affiant's Address
State of
County of
(affix corp. seat)
Attest (Secretary or Assistant Secretary if Affiant is
Officer of Corporation)
Print or type name of Secretary or Assistant Secretary
Sworn to and subscribed before me this day of
By 11 fYa� t S .Lc..C'`'U '~',
(Individual) (Name of Corporation, Partnership or Trust)
on behalf of the Corporation, Partnership or Trust who is personally known to me or who has
produced �_ 1v-�. as identification. C�
Notary' Signature:
(Print write or stamp name of Notary ublic
(SEAL)