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G vo EXHIBIT G
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CITY OF MIAMI
NOTE: As an alternative to the requirements set forth in the above c- ited Code Section, the person filing
this report may provide a copy of the current year's Federal income tax return (See last page for
Instructions).
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LAST NAME FIRST NAME ' MIDDLE INITIAL OFFICE HELD
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RESIDENCE ADDRESS CITY ZIP CODE COUNTY
ASSETS 000:
OVER.$
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DESCRIPTION VALUE Please list below the name and address of every
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person, whether individual or corporation, to
U whom you owe a liability exceeding $ 5, 000,
1 >v 1 1 sw 3 C( A 327 , 1 (r 1̀ and the total amount of indebtedness.
Liability" is defined as any monetary debt or
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1/ obligation owed by you to another person,
cro6, including credit card retail installment accounts;
S 04C $ \ taxes owed; indebtedness on a life insurance
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Name Address
/ of Creditors: Amount- Owed:
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NetNet worthworth isis thethe difference difference between between totaltotal assetsassets andand totaltotal liabilities,liabilities, notnot merelymerely thosethose listedlisted inin
PART PART AA( ( above),above), which which have have aa value value inin excess excess ofof$ $5, 5,
000. Please Please enter enter your your net net worth worth asas ofof
December December 31 31 of of the the taxtax year year or or aa more more recent recent date.date.
00 22, ," ". .` ` 33
MyMy net net worth worth asas ofof JJ, , 2020 YOYO was was
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The The information information disclosed disclosed dem-and onon any any attachments attachments hereto hereto isis true true and and correct correct toto mymy knowledge.knowledge.
ofof 22
On On this this the the
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2020 iUiU, , before before
Florida,Florida, the,foregging r trutnenttrutnent waswas acknpwledgedacknpwledged by:by:. .
me,me, the the undersigned undersigned Notary Notary Public Public of of the the State State of of
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Name Name ofof person person signing signing andand his/her title ti(tle ( public public officer,officer, trustee trustee oror personal personal representative) representative)