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EXHIBIT H
CITY OF MIAMI
0
oF4n.
F PUBLIC DISCLOSURE OF FINANCIAL INTERESTS
T•''

0 N
c' IN COMPLIANCE WITH MIAMI CITY CODE SEC. 2- 619)

Note: As an alternative to the requirements set forth in the above-cited Code Section, a copy of the reporting
person' s filed return for the current year' s federal income tax return may be provided.[ City Code Sec. 2- 619( b)]

LAST NAME
o
FIRST NAME MI
75/ 6.
4.7, iss,
OFFICE HELD

fjD S•a/• A
/o-f- 5 Lida-/ yii• 33/.3 r
MAILING ADDRESS CITY ZIP CODE COUNTY

ASSETANDLIABILITIES IN EXCESS OF$ 5, 0_Q0

AS OF DECEMBER 31 OF THE PRECEDING TAX YEAR)

PART A] -- ASSETS PART B] -- LIABILITIES

DESCRIPTION VALUE Please list below the name and address of every person,
whether individual or corporation, to whom you owe a-

liability exceeding $ 5, 000, and the total amount of


D( • QOOdd indebtedness. " Liability" is defined as any monetary debt
or obligation owed by you to another person, including
retnil insealiment taxes owed;

ieev4: a4- 4) t 9.sga ndebtedness on a life insuranceaccponcy


issuing company; or
policy owed to the
accrued income taxes on net
tdS/.(/es S unrealized appreciation.

fr('
1/ 3)00..0
NaAme/ Address of Creditors t Owed

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4299,o aew
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4-1‘ DAO• DO
HOUSEHOLD GOODS/ PERSONAL EFFECTS

Household goods and personal effects may be reported


in a lump sum if their aggregate value exceeds $ 5, 000. o
Examples of household goods include, but are not limited
to, any of the following ( if not held for investment
c f
purposes): jewelry; stamp collections; guns and
numismatic properties; art objects; household equipment
tom
and furnishings; clothing; other household items; and
for personal use. The aggregate value of
my
r= y
i.`
assets as described above is: t

y0, eoo • dPeWi; e w

Note: You are not limited to the space on the lines in this form. Attach additional sheet( s) if necessary_.

Rev. 5/ 2019 Page 1 of 2


PART C] -- NET WORTH

Net worth is the difference between total assets and total liabilities. Please refer to Miami City Code Sec. 2- 619( a- d) when
determining this amount. Enter your net worth as of December 31st of the preceding tax year.

My net worth as of /..


03i aV D/ Q
was $
76: 5---- lgsti„ 7$_

PART D] -- AFFIDAVIT

The information disclosed herein and on any attachments hereto is true and correct to my knowledge.

d./ AL./
ignature o e Person Reporting
7/// fro/?
Date

I/

State of Florida

County of Mkarf; I - Daae.

St

Sworn to( or affirmed) and subscribed before me on this the I day of J IA\
y
p
20 I i ,
by:
t

Name of person signing and his/ her title( public officer, trustee or personal representative)
cm c
v
WITNESS my hand and official seal.
e) r,; c._

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lik L--- s--=---,
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Signat a of No , ry Public
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Name of Notary Typed, Stamped or Printed)
Notary Public, State of Florida

NOTARY PUBLIC

Personally known to me, or SEAL OF OFFICE:

El Produced identification:
Type of Identification Produced) , —_. — — —_...— — — —•
iii c"r,••. TODD B HANNON

I F:\ Notary Public- State of Florida


siri Commission N GG 262274
or r. My Comm. Expires Sep 25, 2022
Bonded through National Notary Assn.

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