Fillable DISCLOSURE OF INTEREST (Town of Cutler Bay)

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DISCLOSURE OF INTEREST (Town of Cutler Bay)

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TOWN OF CUTLER BAY
Department of Community Development
Planning and Zoning Division
(305) 234-4262
Town of Cutler Bay | 10720 Caribbean Boulevard, Suite 105 | Cutler Bay, FL | www.cutlerbay-fl.gov
Received: ____________________
PLAN #: _____________________
DISCLOSURE OF INTEREST
Any party holding at least five percent (5%) interest in the property or proposed project shall
be disclosed to the Town of Cutler Bay. The Applicant is responsible for maintaining this
information as current throughout the application and review process. Failure to provide a
full and complete disclosure of interest at any time during the application, review, and/or
final disposition process will place the application out of compliance with the Town’s Land
Development Regulations and the application will be considered void.
If the property, which is the subject of the Application, is owned or leased by a
CORPORATION, TRUST, PARTNERSHIP, or LIMITED PARTNERSHIP, list the Principal
Stockholders and the percentage of stock owned by each. NOTE: Where the Principal
Officers or Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other
similar entities, further disclosure shall be required which discloses the identity of the
individual(s) (natural persons) having the ultimate ownership interest in the aforementioned
entity. Use multiple forms as necessary.
Name of Corporate Entity: _________________________________________________________________
Name
Address
Office Held
(if applicable)
Percentage
of Interest
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DISCLOSURE OF INTEREST (Town of Cutler Bay)

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Completed 22 January 2021

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