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Home My WebLink AboutTab 25 - Magic City Properties X, LLCSPECIAL AREA PLAN APPLICATION DISCLOSURE OF OWNERSHIP List the owner(s) of the subject property and percentage of ownership. Note: The Miami City Code requires disclosure of all parties having a financial interest, either direct or indirect, with respect to a presentation, request or petition. Accordingly, disclosure of shareholders of corporations, beneficiaries of trusts, and/or any other interested parties, together with their address(es) and proportionate interest are required. Please supply additional lists, if necessary. Owner's Name(es) MAGIC CITY PROPERTIES X, LLC Percentage of Ownership See attached corporate ownership chart. Subject Property Address(es) 365 NE 61 st Street 2. List all street address(es) and legal description(s) of any property located within 500 feet of the subject property owned by any and all parties listed in question #1 above. Please supply additional lists, if necessary. Street Address(es): Legal Description(s): N/A NEISEN O. KASDIN, its Attorney Owner(s) or Attorney Name Owner(s) 6r Attorney Signature STATE OF FLORIDA -- COUNTY OF MIAMI-DADE20 \��' r T foregoing a acknowledged befor a is day ofT 3 )1 tV Nt-Cr who is a n individual artner/a e� ora ion of a n O p 9 tl ( ) individual/partnership/corporation. She is personally known to me or who has produced as identification and who dim. Diana Perez-Gata NOTARY PUBLIC (Stamp) _;j',r STATE OF FLORIDA Comm# FF233833 Expires 6/8/2019 Rev. 07-2013 7 AAA 2012 Trust BENEFICIARIES: Alexa, Ashley & Amber Zangrillo 16244thAve., Ste 400 Seattle, WA 98101 42.49% Robert Zangrillo 11 E Dilido Dr. Miami Beach, FL 33139 Neil Kadisha 9420 Wilshire Blvd. Ste. 400 Beverly Hills, CA 90212 54.2% 3.31% MCD Dragon, LLC, a Delaware limited liability company 1209 Orange St. Wilmington, DE 19801 The Akai Tsuki Family Trust BENEFICIARIES: Guy Laliberte Naima M. Laliberte Kami M. Laliberte Moani Taini M. Laliberte Noa Taima B. Laliberte Ina Kai B. Laliberte 2200 Rue Stanley Montreal, H3A 1 R6 Canada 1% MAGIC CITY PROPERTIES X, LLC OWNERSHIP CHART Guy Laliberte 2200 Rue Stanley Montreal, H3A 1 R6 Canada 99% Lune Rouge Illusion CT Inc., a Delaware corporation 251 Little Falls Dr. Wilmington, DE 19808 Anthony Cho 3737 Collins Ave. Apt. 1104 Miami Beach, FL 33137 100% • CHO MCD, LLC, a Delaware limited liability company 1209 Orange St. Wilmington, DE 19801 MCD Miami, LLC, a Delaware limited liability company One SE 3rd Ave., Ste. 2110 Miami, FL 33131 The Anthony Burns Revocable Trust BENEFICIARY: Jessica Lynn Bums 2675 Hunter Ct. Weston FL 33331 George Helmstetter 550 Sabal Palm Rd. Miami, FL 33137 Charles & Valerie Rennert 156 Bal Cross Dr. Bal Harbor, FL 33154 31.281% 17.444% Neil Fairman 180 Palm Ave. Miami, FL 33139 100% Magic City Properties X, LLC, a Delaware limited liability company One SE 3rd Ave., Ste. 2110 Miami, FL 33131 48.725% 0.428% Howard & Amy Vogel 2127 Brickell Ave., Apt. 1002 Miami, FL 33129 0.428% 0.847% Jose & Sandra Rodriguez 498 SW 27th Road Miami, FL 33129 0.847% Jeffrey & Rebecca Mandler 12525 SW 69th Ave. Miami, FL 33156 PEP Magic City Development, LLC, a Florida limited liability company One SE 3rd Ave., Ste. 2110 Miami, FL 33131 Owns: 365 NE 61st St. WRITTEN CONSENT OF MAGIC CITY PROPERTIES X, LLC The undersigned, being the Sole Member and Manager of Magic City Properties X, LLC, a Delaware limited liability company (the "Company"), does hereby consent and agree to the adoption of, and does hereby adopt, the following resolutions of the Company in lieu of holding a meeting in accordance with the governing documents of the Company, and directs that these resolutions be filed in the records of the Company: WHEREAS, in regard to the Company's properties at 365 NE 6l st Street in Miami, Florida, the undersigned Sole Member and Manager deems it advisable and in the best interests of the Company for the Company to join in and submit an application to the City of Miami seeking approval of the Magic City Innovation District Special Area Plan and related Comprehensive Plan Amendments, generally prepared in accordance with the application forms published by the City of Miami (collectively, the "Application"); and WHEREAS, in connection with the preparation, filing and formal review and processing of the Application, including without limitation the execution and delivery of any and all documents and forms required for the Application, the undersigned Sole Member and Manager deems it advisable and in the best interests of the Company for the Company to grant Neisen O. Kasdin, T. Spencer Crowley III, Steven J. Wernick and Benjamin O. Hedrick a power of attorney pursuant to that certain Power of Attorney attached hereto as Exhibit A (the "Power of Attorney"). NOW THEREFORE, BE IT RESOLVED, that the Application and the Power of Attorney are hereby authorized, approved, adopted, confirmed and ratified in all respects; FURTHER RESOLVED, that any member, manager, officer or other authorized representative of the Company (each being referred to herein as an "Authorized Person"), including without limitation Neil Fairman, Anthony Burns and George Helmstetter, acting alone, be and hereby is, authorized and empowered to execute and deliver on behalf of the Company any and all agreements, instruments, certificates or documents necessary to consummate or effectuate the Application and the Power of Attorney, in the name and on behalf of the Company; FURTHER RESOLVED, that each Authorized Person is hereby authorized, empowered and directed, in the name and on behalf of the Company to make or cause to be made, and to execute and deliver, all such agreements, documents, instruments and certifications, and to do or cause to be done all such acts and things, and to take all such steps, as he or she may at any time or times deem necessary or desirable in order to carry out the intent and purposes of the foregoing resolutions; and FURTHER RESOLVED, that the authorities and approvals hereby conferred shall be deemed retroactive, and any and all acts authorized and approved herein that were performed prior to the passage of this resolution be, and they hereby are, approved, ratified and confirmed in all respects. [Signature on following page] 1N WITNESS WHEREOF, the undersigned has executed this Written Consent as of the 3 O day of AVOV€w44eA. , 2017. COMPANY: MAGIC CITY PROPERTIES X, LLC By: MCD Miami, LLC, its Sole Member and Manager By: Name: George Helmstetter Title: Authorized Representative EXHIBIT A Power of Attorney POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that MAGIC CITY PROPERTIES X, LLC, a Delaware limited liability company, has made, constituted and appointed, and by these presents do make, constitute and appoint NEISEN O. KASDIN, T. SPENCER CROWLEY IH, STEVEN J. WERNICK, and BENJAMIN O. HEDRICK its true and lawful attorneys in its stead to execute all documents and instruments required with respect to applications for a Special Area Plan and Comprehensive Plan Amendment, in connection with the Magic City Innovation District Special Area Plan, under the requirements of the City of Miami Code of Ordinances and Miami 21 zoning code, submitted to the Office of Hearing Boards, for the properties located at 365 NE 61 st Street in Miami, Florida, giving and granting unto NEISEN O. KASDIN, T. SPENCER CROWLEY III, STEVEN J. WERNICK, and BENJAMIN O. HEDRICK its said attorneys, full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done with respect to the aforementioned Special Area Plan and Comprehensive Plan Amendment applications as fully, to all intents and purposes, as it might or could do if personally present (including, without limitation, preparing, executing and filing all documents and applications and attending all hearings and meetings), with full power of substitution and revocation, hereby ratifying and confirming all that said attorney or his substitute shall lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF, I have hereunto set my/our hand(s) and seal(s) this 20 day of Tetery oer , 2017. Signed and delivered in the presence of: Witness Signatu' YYItr►a Cron Witness Name Wii✓ness Signature JD c•-f Cot-stk., Witness Name STATE OF FLORIDA COUNTY OF NIIAMI-DADE ) SS: Magic City Properties X, LLC By: /yes Name: George Helmstetter Title: Authorized Representative The foregoing instrument was acknowledged before me this 20 day of tevflo.6(_ den by Ce}(j RelmsAttter who is ersonally known to me or who has produced a as identification. N OZP 4OFFLOP\ ;e`% MARIA GONZALEZ * MY COMMISSION # FF 909142 EXPIRES: October 22, 2019 Bonded Thru Budget Notary Services NOTARY PUB / C Print Name: My commission expires: h Delaware The First State 111 t,-0 2 CR R CO OD 4-1 -2 OR BK. 30814 Ps 1327-1328 (2P95) NEuORDED 01/03/2018 11:362? HARVEY RUVINy CLERK OE COURI MIAMI-DADE COMM FLORIDA Page 1 I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT COPY OF THE (...e.,TIFICATE OF MERGER, WHICH MERGES: "365 NE 61ST STREET, LLC", A FLORIDA LIMITED LIABILITY COMPANY, WITH AND INTO "MAGIC CITY PROPERTIES X, LLC" UNDER THE NAME OF "MAGIC CITY PROPERTIES X, LLC", A LIMITED LIABILITY COMPANY ORGANIZED AND EXISTING UNDER THE LAWS OF THE STATE OF DELAWARE, AS RECEIVED AND FILED IN THIS OFFICE ON THE TWENTY—FIRST DAY OF DECEMBER, A.D. 2017, AT 4:03 O'CLOCK P.M. AND I DO HEREBY FURTHER CERTIFY THAT THE EFFECTIVE DATE OF THE AFORESAID CERTIFICATE OF MERGER IS THE TWENTY—FIRST DAY OF DECEMBER, A.D. 2017 AT 5 O'CLOCK P.M. 5583564 8100M SR#20180008829 You may verify this certificate online at corp,delaware.gov/authver.shtml Jefray W. Uvliotb. Sttletary M Wolf Authenticatioill: 201902639' d'ote'; 01-02-18', "...G R LL.. K --_r i@ 8 1 -tea- k `'w B. 3' 2 LAST PAGE STATE OF DELAWARE CERTIFICATE OF MERGER of a Foreign Limited Liability Company into a Domestic Limited Liability Company State of Delaware Serretary of Slate Division of Corporations Delivered 04;03 P2112//21!2017 FILED 04:03 P1112121017 SR 20177726239 • Flle\unber 5$53564 Pursuant to Title 6, Section 18-209 of the Delaware Limited Liability Company Act. FIRST: The name of the surviving Limited Liability Company is Magic City Properties X, LLC, a Delaware Limited Liability Company. SECOND: The name of the limited liability company being merged into this surviving Limited Liability Company is 365 NE 61ST Street, LLC. The jurisdiction in which this limited liability company was formed is Florida. THIRD: The Agreement of Merger has been approved and executed by both limited liability companies. FOURTH: The name of the surviving Limited Liability Company is Magic City Properties X, LLC, a Delaware limited liability company. FIFTH: The merger shall become effective at 5:00 p.m. EST on the date the Certificate of Merger is filed with Delaware Secretary of State. SIXTH.: A copy of the executed Agreement of Merger is on file at the principal place of business of the surviving Limited Liability Company, SEVENTH: A copy of the Agreement of Merger will be furnished by the surviving Limited Liability Company, on request, without cost, to any member of the constituent entities. IN WITNESS WHEREOF, said Limited Liability Company has caused this certificate to be signed by an authorized person this 141h day of December, 2017. MAGIC CITY PROPERTIES X, LLC, a Delaware limited liability company By: Name; Ant on Title: Aut. prized Signatory 1111 111[1111[1 I 1111 1111111' 11111111 11 I EN 2.018RC 004-123 OR BK 30814 P9'5 132°-1330 (2P9s) RE()k[ F 1 11;;(.A2( HARVEY RUVIN XERK or UHT MAE -DADE COUNTY FLORIDA Brparttnrnt of #tatr I certify the attached is a true and correct copy of the Articles of Merger, filed on December 21, 2017 as shown by the records of this office. The document number of the surviving corporation is M14000005721. CR2E022 (1-11) Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Twenty-ninth day of December, 2017 .-.R !thnr SocrofarvnfMute 12-21-' 17 16:35 FROM - FAX AUDIT NO.: H17000335053 3 BK 3081, PG 1 :5 _� F t PAGE "s T-106 P0002/0002 F-027 ti , <7/ ARTLCLEs Olr 1vIERVI e..', 4, FOR d FLORIDA L, MTTED LIABILITY COMPANY Sg The following Articles of Merger are submitted to merge the following'Florida limited liability company into a foreign entity in accordance with Section 605,1025, Florida Statutes, FIRST; The exact name, jurisdiction, and Name 365 NE 61ST Street, .LLC SECOND: The exact name, jurisdiction, and Nam4 Magic City Properties X, LLC form/entity type of the me7pi_tty is as follows; Jurisdiction Eorm[EntityType Florida Limited liability company form/entity type of the eurvivinp, party is as follows: Jurisdiction ForrnLFntityloc Delaware Limited liability company The surviving entity is an existing foreign entity that already has a certificate of authority to transact business in this state. TTIDtD: The merger was approved by the foreign surviving entity in accordance with the laws of its jurisdiction, by the domestic mergtng limited liability company in accordance with Sections 605.1021-605,1026, F,S,, and by each member ofsuch I'smitod liability company who as a result of the merger will have interest holder liability under Section 603,1023(1)(b), F,S. FOURTH: This merging Florida ontity agrees to pay any members with appraisal rights the amount to which members are entitled under Sections 605.1006 and 605,1061.605.1072, F,S. FIFTH': The merger shall become effective at 5:00 p.m. BST on the date the Articles of Merger are filed with Florida Department of State. SIXTH: The Articles of Merger comply and were executed in accordance with tht laws of each party's applicable Jurisdiction. IN WITNESS WHEREOF, the undersigned have signed their names and affirmed that the statements herein are true, under penalties of perjury, this 14th day of December 2017. 365 NE 61ST Street, LLC, MAGIC CITY PROPERTMS X, LLC, a Florida limited liability company a Delaware limited liability company By: Name: A{dthony 13tirns Title: A horized Signatory >3y; Name: Apfhony Bur Title: Authorized Signatory FAX AUDIT NO.: H17000335053 3 THIS INSTRUMENT WAS PREPARED BY: Michael S. Tobin, Esq. Rothman & Tobin, P.A. 11900 Biscayne Boulevard. #740 Miami, FL 33181 Folio No.: 01-3218-015-0730 111111111111111111111111111111111111111111111 C=FH 2014R00870712 OR Bk 29436 F9s 4293 - 4297; (5a9s) RECORDED 12/19/2014 15:11:57 DEED DOC TAX 6,600.00 SURTAX 41950.00 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA SPECIAL WARRANTY DEED THIS INDENTURE, made this /Q day of December, 2014, between W & G Investments, a dissolved Florida general partnership by Gioacchino J. Grieco, Jr. as the last and only surviving general partner ("Grantor"), and 365 NE 61st Street, LLC, a Florida limited liability company, whose address is 600 Brickell Ave, Ste. 3500 Miami, FL 33131 ("Grantee"), and whose federal taxpayer identification number is: 59-1838029: WITNESSETH THAT: Grantor, for and in consideration of the sum of Ten and No/100 U.S. Dollars ($10.00), lawful money of the United States of America, to it in hand paid by the Grantee, at or before the ensealing and delivery of these presents, the receipt of which is hereby acknowledged, has granted, bargained, sold, alienated, remised, released, conveyed and confirmed and by these presents does grant, bargain, sell, alien, remise, release, convey and confirm unto the Grantee and its/his/her heirs or successors and assignees forever, the following parcel of land, situate, lying and being in the County of Miami -Dade ("County"), State of Florida, and more particularly described as follows: SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF (the "Land"). SUBJECT, HOWEVER, TO THE FOLLOWING: Real property taxes and assessments, for the year 2015 and for subsequent years. Zoning and other regulatory laws and ordinances affecting the Land. Easements, reservations, restrictions, rights of way, and other matters of record set forth in EXHIBIT B attached hereto (without thereby re -imposing the same). TOGETHER with all and singular the tenements, hereditaments and appurtenances thereunto belonging or in any way appertaining. TO HAVE AND TO HOLD the same in fee simple forever. AND the Grantor hereby covenants with said Grantee that it is lawfully seized of the Land hereby conveyed in fee simple; that it has good right and lawful authority to sell and convey said Book29436/Page4293 CFN#20140870712 Page 1 of 5 Land; that it hereby specially warrants the title to said Land and will defend the same against the lawful claims of any persons claiming by, through or under the said Grantor but against no others. [TEXT AND SIGNATURES FOLLOW] Book29436/Page4294 CFN#20140870712 Page 2 of 5 WITNESS my hand and seal this 1 Oiday of December, 2014. Signed, sealed and delivered GRANTOR: in the presence of witnesses: W & G INVESTMENTS, ``3AL nn a dissolved Florida general partnership Si Print Name: Cj®C Y1Q niztecio By.:- yirxcr Gioacchino J. Grieco, general partner only survi STATE OF FLORIDA ) : SS COUNTY OF MIANII-DADE ) The foregoing instrument was sworn to and acknowledged before me this day of December, 2014, by Gioacchino J. Grieco, Jr., as last and only surviving general artner of W & G Investments, a dissolved Florida general partnership, who is [ rsonally known )or [ ] has produced as identification and who did not take an oath. ci? NOTARY PUBLIC; State Flo Print Name:She 1 My Commission Expires: !uaStiaON1a69411 PaPuo8 o\ veog LIOZ'elegwenoN S3didX3 61t6S0 dd * Z3fD HUON 11113HS '3,eea ao.° Book29436/Page4295 CFN#20140870712 Page 3 of 5 EXHIBIT A LEGAL DESCRIPTION Lot 4, Block 18. of SECOND CORRECTED PLAT OF PIERCE'S SUBDIVISION OF LEMON CITY, according to the Plat thereof as recorded in Plat Book 2, Page 21, of the Public Records of Miami -Dade County, Florida AND LESS the South 2.5 feet and LESS AND EXCEPT that portion of Lot 4, Block 18 of SECOND CORRECTED PLAT OF PIERCE'S SUBDIVISION OF LEMON CITY, according to the Plat thereof as recorded in Plat Book 2, Page 21, of the Public Records of Miami -Dade County, Florida, which lies North of a line that is 25.00 feet South of, as measured at right angles, and parallel with the center line of N.E. 62 Street, as said center line as shown on the plat of JOYCE PROPERTIES SUBDIVISION, according to the plat thereof recorded in Plat Book 51, page 38, of the Public Records of Miami -Dade County, Florida, pursuant to Order of Taking recorded in Book 10738, page 1721 together with Final Judgment as to Parcel Nos 42 and 44 recorded in Book 10877, page 2093. Book29436/Page4296 CFN#20140870712 Page 4 of 5 OR BK 2943,E PG, 4297 LAST PAGE EXHIBIT B TO DEED 1. Taxes and assessments for the year 2015 and subsequent years, which are not yet due and payable. 2. Restrictions, covenants, conditions, dedications, easements and other matters as contained on the Plat of Pierce's Subdivision of Lemon City, recorded in Plat Book B, Page 42, as corrected in Plat Book B, Page 43, Plat Book B, Page 117 and Plat Book 2, Page 21, of the Public Records of Miami -Dade County, Florida. 3. Easement(s) in favor of Florida Power and Light set forth in instrument(s) recorded in Official Records Book 12039, Page 1499. 4. Interest of Lessee(s) together with terms, covenants, conditions, provisions, burdened easements, rights, duties, obligations and other matters contained in that certain unrecorded Lease with Christian Kolm d/b/a Christina Kolm Cosmetics, Inc., dated May 1, 2013. 5. The following state of facts as disclosed by survey prepared by John Ibarra & Associates, Inc., originally dated June 20, 2013, with the last revision on October 2, 2014, under Job No. 13-002220-2: a.) Encroachment onto adjoining property of 0.30 foot of 3 foot concrete and brick wall with 6 foot wood fence on the Northeast corner. b.) Encroachment of subject property of 0.40 foot of 3 foot concrete and brick wall with 6 foot wood fence onto sidewalk in the Northwest comer. c.) Encroachment onto subject property of 0.10 foot of 1 foot concrete and brick wall with 7 foot wood fence on the upper Southwest comer. d.) Encroachment onto subject property of 0.10 feet to 0.50 feet of a 7 foot wood fence in the Southwest corner. Book29436/Page4297 CFN#20140870712 Page 5 of 5 State of Florida Department of State I certify from the records of this office that MAGIC CITY PROPERTIES X, LLC is a Delaware limited liability company authorized to transact business in the State of Florida, qualified on August 11, 2014. The document number of this limited liability company is M14000005721. I further certify that said limited liability company has paid all fees due this office through December 31, 2018, that its most recent annual report was filed on March 7, 2018, and that its status is active. I further certify that said limited liability company has not filed a Certificate of Withdrawal. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Fifth day of June, 2018 i&-s% Secretary of State Tracking Number: CU5105810084 To authenticate this certificate,visit the following site,enter this number, and then follow the instructions displayed. https://services.sunbiz.org/Filings/CertificateofStatus/CertificateAuthentication Delaware The First State I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT COPY OF THE CERTIFICATE OF .FORMATION OF "MAGIC CITY PROPERTIES X, LLC', FILED IN THIS OFFICE ON THE EIGHTH DAY OF AUGUST, A.D. 2014, AT 2:41 O'CLOCK P.M. 5583564 8100 SR# 20177815322 You may verify this certificate online at corp.delaware.gov/authver.shtml Page 1 Authentication: 203845373 Date: 12-28-17 State of Delaware Secretary of State Division of Corporations Delivered 02:47 PM 08/08/2014 FILED 02:41 PM 08/08/2014 SRV 141052316 - 5583564 FILE STATE of DELAWARE LIMITED LIABILITY COMPANY CERTIFICATE of FORMATION • First: The name of the limited liability company is Magic City Properties X, LLC • Second: The address of its registered office in the State of Delaware is Corporation Trust Center, 1209 Orange Street in the. City of Wilmington , . 1.9 8 01 . The name of its Registered agent at such address is The Corporation Trust Company • Third: (Use this paragraph only ifthe company is to have a specific effective date of dissolution: "The latest slate on which.the:limited liability company is to dissolve is • Fourth: (Insert any other matters the members determine to include herein.) lit Witness Whereof. the undersigned have executed this Certificate of Formation this 8 day of AUertirr , 20 14 hFAg3 6/ Dd15 CT Splism !NUM! By: Authorized Person(s) Name:. Dede Lofuts Typed or Printed 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: Neisen O. Kasdin (First Name) (Middle) (Last Name) HOME ADDRESS: c/o Akerman LLP, 98 SE 7th Street, Suite 1100 CITY: (Address Line 1) (Address Line 2) Miami STATE: Florida HOME PHONE: (3 0 5) 9 8 2- 5 6 2 9 CELL PHONE: FAX: EMAIL: neisen.kasdin@akerman.com ZIP: 33131 BUSSINESS or APPLICANT or ENTITY NAME Magic City Properties X, LLC BUSINESS ADDRESS: One SE 3rd Avenue, Suite 2110 (Address Line 1) Miami, FL 33131 (Address Line 2) 1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board, authority, agency, council, or committee. Approval of the Magic City Innovation District Special Area Plan (SAP). 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 0 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 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 Phoneft a. n/a b. c. * Additional names can be placed on a separate page attached to this form. 4. Please describe the nature of the consideration. n/a 5. Describe what is being requested in exchange for the consideration. n/a 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 same issue shall be reviewed or considered by the applicable board(s) until expiratio a eriod of one year after the nullification of the application or order. PERSON SUBMITTING DISCLOSURE: b gnatu Neisen O. Kasdin Print Name Sworn to and subscribed before me this day o Q0 The foregoing instrument was acknowledged before me by who has produced not take an oath. Diem RiPe7t ion and/or ' and who did/did ,CI i'lli NOTARY PUBUC STATE OF FLORIDA STATE OF FLO :016.•.30:_ Cannm#FF233833 CITY OF MIAMI '-. . Expires 6/8/2019 MY COI\-TMiSSION Notary 1 �, EXPIRES: � ��'- / opo_y \ �� '`� Print Name Enclosure(s) Doc. No.:86543 Page 2 Corrected Paid By 365 NE 61st Street LLC Miami -Dade County, Florida Paid 12/11/2017 plicate public user 06/04/2018 Receipt# ECHECK-18-089926 $17,918.43 2017 Real Estate Property Taxes Notice of Ad Valorem Tax and Non -Ad Valorem Assessments SEE REVERSE SIDE FOR IMPORTANT INFORMATION FOLIO NUMBER MUNICIPALITY MILL CODE 01-3218-015-0730 MIAMI 0100 365 NE 61 ST ST LLC 1 SE 3 AVE 2110 MIAMI, FL 33131 Property Address 365 NE 61 ST Exemptions: AD VALOREM TAXES Miami -Dade School Board School Board Operating School Board Debt Service State and Other Florida Inland Navigation Dist South Florida Water Mgmt Dist Okeechobee Basin Everglades Construction Proj Childrens Trust Authority Miami -Dade County County Wide Operating County Wide Debt Service Library District Municipal Governing Board Miami Operating Miami Debt Service 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 6.77400 0.22000 0.03200 0.12750 0.13840 0.04410 0.46730 4.66690 0.40000 0.28400 811,158 7.43650 811,158 0.59350 NON -AD VALOREM ASSESSMENTS RA 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 811,158 5,494.78 178.45 25.96 103.42 112.26 35.77 379.05 3,785.59 324.46 230.37 6,032.18 481.42 Save Time. Pay Online. www.miamidade.gov t RETAIN FOR YOUR RECORDS t (Combined taxes and assessments $17,183.71 i 2017 Real Estate Property .. DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT 4- Taxes FOLIO NUMBER 01-3218-015-0730 PROPERTY ADDRESS 365 NE 61 ST LEGAL DESCRIPTION 18 53 42 PB B-43 & PIERCES DIV LEMON CITY PB 2-21 & LOT 4 LESS S2.5FT & LESS 365 NE 61 ST ST LLC 1 SE 3 AVE 2110 MIAMI, FL 33131 11111111111 II 11111111 II 0 1 3 2 1 8 0 1 5 0 7 3 0+ Make checks payable o: Miami -Dade Tax Collector (in U.S. funds drawn on U.S. banks) Amount due May be Subject to Change Without Notice Mail payments to: 200 NW 2nd Avenue, Miami, FL 33128 Du.licate .ublic user 06/04/2018 PAY ONLY ONE AMOUNT If Paid By Please Pay Mar 31, 2018 $0.00 1000000000000000000132180150730201700000000000000000000002