EXHIBIT H

t F CITY OF MIAMI
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PUBLIC DISCLOSURE OF FINANCIAL INTERESTS

O R
o 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)]

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S.S/ 674/ 4'217.—
LAST NAME FIRST NAME MI OFFICE HELD

RESIDENCE ADDRESS CITY ZIP CODE COUNTY

ASSETS AND LIABILITIES IN EXCESS OF $ 5. 000

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,
L ..4._.
whether individual or corporation, to whom you owe a
T
iability exceeding $ 5, 000, and the total amount of

ji,L1,5- e_ 1„ 2,c,00, ea windebtedness. " Liability" is defined as any monetary debt

or obligation owed by you to another person, including
credit card retail installment accounts; taxes owed;

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7 indebtedness on a life insurance policy owed to the
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issuing company; or accrued income taxes on net
AjOa g$15 unrealized appreciation.

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,Ated-,-
Name/ Address of Creditors Amount Owed

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ca HOUSEHOLD GOODS/ PERSONAL EFFECTS ` //`
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HoufeoldLoods
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and personal

if their aggregate
effects may be reported
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a
lump sum value exceeds $ 5, 000. '* /)
Examples of household goods include, but are not limited / "!'" G/ es
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to, any of the following ( if not held for investment 4'-f
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purposes): jewelry; stamp collections; guns and ° 3Si `

numismatic properties; art objects; household equipment

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and furnishings; clothing; other household items; and
vehicles for personal use. The aggregate value of my
assets as described above is:

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

Rev. 5/ 2016 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 / f
3 / was $
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PART D] -- AFFIDAVIT

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

I 7 d / Y
signatur a• erson
Reporting Date
i

State of Florida

1
County of MI O. W\ 1— bOl Af__
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Sworn to( or affirmed) and subscribed before me on this the \ — day of IA\
y 20 I B,
by:

Joy- CroI I o , Cnv-

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Name of person
signing and his/ her title( public officer, trustee or personal representative) c, ,.,,

WITNESS my hand and official seal.

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SignatureNotary Public c- 7

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ICAA e) - Nortnon
Name of Notary Typed, Stamped or Printed)
Notary Public, State of Florida

NOTARY PUBLIC

known to SEAL OF OFFICE:

Personally me, or

Produced identification:

Type of Identification Produced)

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TODD B. HANNON
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4 :* ', Notary Public- State of Florida
E My Comm. Expires Aug 22, 2018
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I Commission# FF 128107

Bonded Through National Notary Assn.

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