HomeMy WebLinkAboutApplication & Supporting DocsAWrT
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HEARING BOARDS
444 SW 2nd Avenue, 7th Floor • Miami, Florida 33130
Telephone 305-416-2030 • Fax 305-416-2035 www.miamigov.com/hearing boards ID,..01;ko J-�o�
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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 pm, except on the fifth day, 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 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 xl 1") 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.
Rev. 12-16-08
Please refer to Chapter 55 of the Miami City Code for Vacation and Closure information.
1. Applicant name(s): Hernando Carrillo, Owner and Architect, on behalf of Inigo Enterprises, Inc.
2. Two (2) copies of the Tentative Plat: One (1) 24 x 36" and one (1) 8 1/2 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 %/2 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 1/2 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).
2 Rev. 12-16-08
Signat
15. 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.
16. What is the acreage of the project/property site? 0.51
17. What is the purpose of this application/nature of proposed use? Vacate and close utility
& pedestrian easement & turnaround area.
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
2. Minimum
b. Re -submittals:
1. Per square foot of right-of-way
2. Minimum
3. Maximum
Public hearing and public meeting mail notice fees,
including cost of handling and mailing per notice
$ .90 _
$ 1,200.00
$ .90
$ 1,200.00
$ 1,700.00
$ 3.50
*Pursuant to Ord' . nce 1271 •, all planning and zoning fees in excess of $25, 000. 00,
sha•ttHiiO
/ y -form of a c- ified check, cashier's check, or money order.
Mailing Address 2225 SW 19 Avenue
Name Her ndo Carrillo
Telephone 305-858-3934
Miami, FL 33145
E-mail hcarchitects(agmail.com
STATE OF FLORIDA -- COUNTY OF MIAMI-DADE
The foregoing w a nowt= • •e ,eforeeffie this ® day of
2042—, by /, i, I O
who is a(n) indwi4ul/partner/agent/corporation of � a(n)
indivi-du I/ artnershi /cor oration. /She is personally own to me or who has •roduced
�- IrIY � �.i�Cr�t�p p �, p Y — ---- ---- as ideritiflca Ion and who did (did not) take an oath.
Cyr
ti,Y s % ,,, ANEL RODRIGUEZ
(Stamp) ,„; MY COMMISSION # DD 681036
"�; EXPIRES:June 12, 2011
;•;., -
p F;, Bonded Thru Notary Public Underwriters
i3
Signature
Rev. 12-16-08
AFFIDAVIT OF AUTHORITY TO ACT
Before me, the undersigned, this day personally appeared
, who being by me first deposes and says:
1. That he/she is the owner, or the legal representative of the owner, submitting the
accompanying application for a public hearing as required by the Code of the City of
Miami, Florida, affecting the real property located in the City of Miami, as described and
listed on the foregoing pages of this affidavit and made a part thereof.
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, 0 including or
0 not including responses to day to day staff inquires.
3. That the foregoing pages are made a part of this affidavit contain the current names,
mailing addresses, telephone numbers and legal descriptions for the real property of
which he/she is the owner or legal representative.
4. The facts as represented in the application and documents submitted in conjunction
with this affidavit are true and correct.
Further Affiant sayeth not.
�E)�t/4-ira-o 6/-1(WiL,2::'
Applicant(s) Name
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoin a� w---as acknowledged before me this day of 5
20 / i' , by , f- e-41, M"v Ci/L�
who is a(n) indd/partner/agent/corporation of
a(n) individual/partnership/corporation. partnership/corporation. He/She i erson a known to me or who
has produced as identification and who i (did not) take an oath.
(Stamp
Rev.
CUBA CASTILLO
-*tory Public - State of Florida
• My Comm. Expires May 3, 2014
.a Commission # OD 985195
-04-c; �� �r _ bonded Through National Notary Assn.
4
Signature
DISCLOSURE OF OWNERSHIP
:LiOt:the OWher(s). Of the: .SObjebt:I4t4e ,and'percentage orownerShip. cNotet .tho
Miami City Cade requires disclosure of all parties having
direct a- :indirea, with respect to, a presentation,, request oT petition. 0POr.d1001Y,...,
disclosure of shareho)der.,0.-:Of ,POrijnratfOriS, :baliefroiariet of trusts, andlor any ...other
interested parties, together with ther addresS(es).. and: proportionate •interest are
TettOired:. .Please SOpply.additiOrial ItStS,:if neddiSary
. .. • . .
•Owner:Nor11.-q0EnterpriSeS,ltia..ttiiertvccrtilio..5dei44i46nindo:darrifici:50PA
Percentage Of Ownership. ,.SherrY Hernandb:Carrillo..50%
.Subjeot IFToPertyAddreSs(e .166-tVi.hd,
List all Street address(es) 6rci iegpid ti ope I6Oated, Within .500 fief,
of -the subject property owned :by any and all. parties i!ttp0 inqueStiOn.#1 aboVe PleaSe.
suPlj.I.Si additional liSt8;:if necessary.
Street Addresses).:
None
Sheny.Oartilid /HarnancfO Carnllo
. ,
OWner(s).erAttorneY Narne.;
!STATE OF FLORIDA — COONtY; or OIAMIrDADE'„
The foregoing was acknowledged before me thiS day of
20. JO by C
who is ac: .individua pailner ttcorporation of.
a(n) indiVidpa pArtriprshiptcOporail0h. Heishols hoWn to .616or who
has produced as identification and who did (did riot)take an oath
A .
Legal
.(StpiTiP).
ow/it/olio
',vdrai.0.4#4.4:APA.#0.410'.4
Signature.
.Ref41:2-10,o.a
OPINION OF TITLE
TO: -CITY OF MIAMI, a municipal corporation
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 City of Miami Code and as an inducement for acceptance of a
proposed final subdivision plat covering the real property hereinafter described. It is hereby certified
that we have examined the complete Abstract of Title completely covering the period from the
beginning to July 24, 2010 at 11:00 PM, inclusive, of the following described real property:
See Exhibit A attached hereto.
Basing my opinion on said complete abstract or title policy covering said period I am of the
opinion that on the last mentioned date the fee simple title to the above described real property was
vested in:
_Ingo Enterprises, Inc., a Florida corporation ,
Note: Sherry Carrillo, as president of Inigo Enterprises, Inc., is authorized to execute
documents on behalf of Inigo Enterprises, Inc.
Subject to the following encumbrances, liens and other exceptions:
GENERAL EXCEPTIONS'
1. All taxes for the year 2008 and the year in which this opinion is rendered and
subsequent years.
2. Rights or claims of parties in possession not shown by the public records.
3. Facts that would be disclosed by an accurate survey and inspection of the premises.
4. Easements or claims of easements not shown by the public records.
5. Any unrecorded labor, mechanics or materialmen liens.
6. Zoning and other restrictions imposed by governmental authority.
1
7. Taxes or special assessments which are not shown as existing liens by the public
records.
SPECIAL EXCEPTIONS
1. Mortgage to BYE Finance, LLC, dated May 30, 2008, recorded on June 4, 2008 in O.R.
Book 26412, Page 2943, of the Public Records of Miami -Dade County, Florida, in the
original principal amount of $250,000.00.
2. Future Advance Receipt and Modification of Mortgage and Promissory Note Secured
Thereby executed by Inigo Enterprises, Inc. to BYE Finance, LLC, dated August 8,
2008, recorded on August 22, 2008 in O.R. Book 26534, Page 2777, of the Public
Records of Miami -Dade County, Florida, increasing the principal amount to
$330,000.00.
3. Mortgage to BPD Bank, dated May 14, 2009, recorded on May 26, 2009 'in O.R. Book
26878, Page 1046, of the Public Records of Miami -Dade County, Florida.
4. All matters contained on the Plat of Vizcatran Gardens, as recorded in Plat Book 129,
Page(s) 89, Public Records of Miami -Dade County, Florida.
5. Declaration of Restrictive Covenants recorded in O.R. Book 12936, Page 2532, Public
Records of Miami -Dade County, Florida.
6. Dedication recorded in O.R. Book 17023, Page 4917, Public Records of Miami -Dade
County, Florida.
7. Application and Acceptance recorded in O.R. Book 16141, Page 5129, Public Records
of .Miami -Dade County, Florida.
. Any Lien provided by Chapter 159, Florida Statutes, or provided by Metropolitan
Dade County Ordinance No. 84-10, in favor of any city, village, town or port
authority for unpaid service charges for service by any water system, sewer system or
gas system serving the lands herein described.
Therefore, it is our opinion that the following parties must join in the platting of the above
described real property in order to grant CITY OF MIAMI, FLORIDA and the public, a good and
proper title to the dedicated areas shown on the final plat of the aforedescribed property, the
subdivision thereof to be known as Carrillo Subdivision:
Name Interest Special Exception
Number
Peacock Development, LLC Fee Simple N/A
BYE Finance, LLC Mortgagee 1 and 2
BPD Bank Mortgage 3
I, the undersigned, further certify that I am an attorney -at -law duly admitted:to practice in
the State of Florida, and am a member in good standing of the Florida Bar.
Respectfully submitted this2/
day of August, 2010.
Robert A. Brandt, P.A.
By:
ROBERT A. BRANDT, ESQ.
696 NE 125 Street
No. Miami, Florida 331.61
305/981-3222
Florida Bar Number: 311391
written.
IFEurC.r, 19389M4I.5
Property Appraisers Folio Number 01-4139-047-0010•
Grantee's Tax Identification Number ti
001:Z57132017 2000 DEC 01 13105
00CSTFDEE 1,260.00 SURTX 0.00
HARVEY RUM, CLERK DADE COUNTY, FL
WARRANTY DEED
(STATUTORY FORM -SECTION 689 02 P.S.)
THIS INDENTURE, executed this' 2dny of jx,, 2000, by
Vizctriran, Ltd., a Florida limited partnership,
Grantor* whose post ofTlcc address Is 7380 N.W. 77'' Court, Medley, FL 33166. to
Inigo Enterprises, Inc., a Florida corporation . .
whose post office address 13 2829 F3ird Ave. Suite 145, Miami, FL 33131, Grantee*.
W 1TNESSETII, That said Grantor, for and in consideration of the sum of Ten 00/100 ($ 10.00) Dollars, and
other good and valuable considerations to said grantor in hand paid by said grantee, the receipt where of is hereby acknowledged,
hat granted, bargained and sold to the said grantee, and grantee's heirs and assigns forever, the following described land, situate.
lying and being In Miami -Dade County, Florida, to -wit•
Tract A, Vizcatran Gardens, according to the map or plat thereof, as recorded in Plat Book 129, at
Page(s) 89, of the. Public Records of Miami -Dade County, Florida.
Subject to: Unpaid taxes for the year 2000 and subsequent years; zoning restrictions imposed by
governmental authority; restrictions and matters contained In or appearing on the Plat or otherwise
common to the subdivision; public utility easements of record.
and aald•Grantor does hereby fully warrant the title to said land, and will defend the same aghinst, the lawful claims of all persons
whomsoever.
`"Grantor" and "Grantee" arc used for singular or plural, as context require
IN WITNESS WHEREOF, Grantor has hereunto set grantor's hand and seal the day and year first above
Signed, sealed and delivered
in our presence:
Print name: ey 6
Print name: %KeS9 Pj Eie4._
STATE OF FLORIDA
COUNTY OF MIAMI DADE
By:
Vizcatrin, Ltd.
JuaniGtanuel Delgado
General Partner
mcoweDHVr+cLA& crJas5coc
oe wet cnwrr, imAc a
RECCWO r[AVIED
HARVEY RUVIN
CLJ:Rx CIRCUIT COURT
(Seal)
I HEREBY CERTIFY that the foregoing instrument was acknowledged before me this 2?day of NO y, ,
2000 by Juan Manuel Delgado, General Partner of Vizcatran Ltd., a Florida Corporation. who Mire personally known to me or
who haa/have produced as
identification and who did take an oath.
WITNESS my hand and official seal In the County and State and on the date last aforesaid.
My Commission Expires:
This Instrument was prepared by:
Robert A. Brandt. Esq.
1110 Brickell Avenue, PH-1
M1dnd, FL 33131
p,RY Pt, onlomNDrARY
•• Hamm A
•awwRoN ar
Qc CC877391
MY `y 2 um
SEPT
Y PUBLIC, State of Florida
"EX
LEGAL DESCRIPTION
A portion of tract "A' V izcatran Gardens as recorded in Plat Book 129 at Page 89 of the Public
Records of Miami Dade County Florida together with a 35' foot Right of Way on the West side
of said plat and North of SW 22nd Terrace as shown on the above named plat of V izcatran Gardens
more particularly described as follows:
Beginning at the NW corner of said plat of Vizcatran Gardens; thence N 87°50'11" E along the
North line of said Tract 'A' for 8320 feet to the West Line of SW 32nd Road as shown on said
plat of Vizcatran Gardens; thence S 37'33'30" E along -said West Line for 104.82 feet to a point
of curvature of' a circular curve concave to the Northwest; thence Southeasterly] Southerly.
Westerly and Southwesterly along the arc of said curve to the right having a radius of 20.00
feet and a central angle of 125'23'41" for 43.77 feet to a point of Tangency said point being on
the North Line of SW 22nd Terrace as shown on the plat of East Shenandoah as recorded in Plat
Book 14 at Page 55 of the Public Record of Miami Dade County Florida and as dedicated to the
City of Miami by ORB 17023 at Page 4917 of the Public Records of Miami Dade County
Florida; thence S 87°56' 11" W along,said North Right of Way line for 127.65 feet to a point on
the Southerly extension of the of said Tract "A"; thence N 02°08'34" W along said Southerly
extension and along the West Line of said Tract "A" for 117.03 feet to the Point of Beginning,
Together with a portion of Tract "A" Vizcatran Gardens as recorded in Plat Book 129 at page 89
of the Public Records of Miami Dade County Florida more particularly described as follows:
Begin at the SW comer of said Tract "A"; thence N 67'43'41"E along the North Line of SW 1st
Avenue as shown on said plat of Vizcatran Gardens for 154.09 feet to a point of curvature of
a curve concave to the Northwest thence Northeasterly, Northerly, Westerly and Southwesterly,
along the West Right of Way Line of SW 32nd Road as said Right of Way is shown on the plat of
East Shenandoah as recorded in Plat Book 14 at Page 55 of the Public Records of Miami Dade
County Florida and along the arc of said curve to the left having a radius of 15.00 feet and a
oentral angle of 159°5330" for 41.86 feet to a point of tangency; said point being on the South
Right of Way Line of SW 22nd Terrace as shown on said plat of East Shenandoah and as
dedicated to the City. of Miami by ORB 17023 at Page 4917 of the Public Records of Miami
Dade County Florida thence S 87°50' 11 + W along said South Right of Way Line for 139.54 feet to
a point on the West Line of said Tract 'A' of Vlzcatran Gardens; thence S 02°09'44' E along said
West line for 82.04 feet to the point of beginning. AU of the above described lands
previously known as lots 34 and 35 block 51 and lot 1 block 52 of East Shenandoah as
recorded in Plat Book 14 at Page 55 of the Public Records of Miami Dade County
Florida. Said lands contain 22,509,4 square feet more or less or 0.52 acres more or less.
Less the following described parcel of land being more particularly described as follows:
Commence at the N.W.:corner of said plat of VIZCATRAN GARDENS; thence South
02°08'34 East for a distance of 82.03 feet to the point beginning; thence South 02°08'34
.:Paanfor:35s00:feet;:thence North, 87150',.1111Eaatfor a:distanemof•35.0afeet
02°08'34"West for a distance of 35.00 feet; thence South 87°50'l1" West for a distance
of 35.00 feet to the point of beginning containing 1225 sq. feet of land.
1
CERTIFIED COPY OF CORPORATE RESOLUTION
AND INCUMBENCY CERTIFICATE
I, as President of Inigo Enterprises, Inc., a Florida corporation, (the ACompanyo) do hereby
certify that the followin g is a true and correct copy of the resolutions adopted by the Company in accordance
with the Florida Law, at which the following resolutions were unanimously adopted:
RESOLVED, that the Company is hereby authorized to apply for and take all actions
necessary and required to obtain plat approval for the Company-s real property being described as:
Tract A, Vizcatran Garden, according to the map or plat thereof as recorded in
Plat Book 129, Page 89, Public Records of Miarni.Dade County, Florida
RESOLVED FURTHER, that Sherry Carrillo, as President of the Company, is hereby
authorized and empowered, in the name of and on behalf of the Company, to execute and deliver any and all
document in connection with the Company=s platting of the above described real property, in such form as
the officer executing such agreement may approve, such approval to be conclusively evidenced by his
execution and delivery thereof; and it is
RESOLVED FURTHER, that Sherry Carrillo, as President of the Company, is hereby
authorized and empowered, in the name and on behalf of the Company, to perform all other acts and things,
and to execute, deliver and file all documents and instruments as such officer may deem necessary or
desirable, in his discretion, to carry out the foregoing resolutions.
I FURTHER CERTIFY that the above resolutions were duly adopted and that Sherry Carrillo, as
President of the Company, and Hernando Carrillo registered agent have full power and authority to bind the
Company pursuant thereto; that the resolutions are in full force and effect and have not been altered,
modified or rescinded, and that Sherry Carrillo is the President of the Company,
IN WITNESS WHEREOF, I have affixed n
STATE OF FLORIDA
COUNTY OF MIAMI DADE
ndan' alon•th•
,/
itaralrEP
Sherry C.o,Tres i den t-
day of August 2010.
1 HEREBY CER 1'lr Y that the foregoing instrument was acknowledged before me this3(_ day of (August 2010;
by Sherry Carrillo, who is personally known to me or produced
identification and who did take an oath.
WITNESS my hand and official seal in the County and Sta and on ie date last aforesaid.
My Commission Expires:
„et Lydia Nowa
My C;ommIzabn DD IT2
Nor, Expires Decemnber22,
PUBLIC, State of Florida
as
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:
HOME ADDRESS:
CITY:
(First Name)
(Middle) (Last Name)
/2466 A-6A-c-a A-d6
(Address Line 1)
HOME PHONE:
EMAIL:
(Address Line 2)
STATE:
Florida
CELL PHONE: `5 O' 8s -3 cj 3L�FAX:
ZIP: B/33
BUSSINESS or APPLICANT or ENTITY NAME
JIGo tiT r_Pr s- . tip
BUSINESS ADDRESS:
(Address Line 1)
(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. _
\ta"17-6 LALL(T\I
\A GA -rt, g-o f-c o
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.
Doc. No.:86543
.;. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided
or committed.
....,,... r..,u, iz,z, r none#
a. i
b. L1 p }
•
c.
* Additional names can be placed on a separate page attached to this form.
4. Please describe the nature of the consideration.
•
• No'N
S. Describe what is being requested in exchange for the consideration.
NONE
ACKNOWLEDGEMENT OF 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 from any person or entity for *the ame issue shall f be reviewed or
considered by the applicabl •01 d(sie it expiry )r`I of a period of one year after the
nullification of the applicl Ica y r, %
PERSON SUBMITTING DISCLOSURE: .� e,. •
i! .. ,= Signatur
i + J
Print Name
Sil'o/77 10 and subscribed before me this 5 clay of 0C.4" , 200 10 . The foregoing
instrument was acknowledged be/ore inc by 4
e%eiao. o CaPr? (1a who has produced
_,
as identification and% "I' Is persona )% `I7o11%17 to me and who did'cficf not take an oath.
STATE OF FLORIDA (//26‘e/Z,a...,,,,,CITY OF MIAIv.11 �L-�-/ L✓ -- •
MY COMMISSION
EXPIRES:
Notary
CWlA CAS13LL0
Enclosure(s) 4
Doc. No.:86543
1.'�Y 3, 2014 Print Name
rrMAl my comm.Expires May
_ page
�-Commisson In# DAD o98519sn
2