Rachel Weissman 06/30/21MlAM IBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._migmibeachf]gov
OFFICE OF THE CITY CLERK
Email: BC@mniamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
srare or FLq&JP,
cOuNT or _DJ-
I, the undersigned, do hereby state under oath, and under penalty of perjury, that the following
facts are true:
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
[L/Resident of the City of Miami Beach for six months or longer.
[] Demonstrates an ownership interest (for a minimum of six months) in a business established
in the City (for a minimum of six months).
Ownership Interest" means the ownership of ten percent (10%) ar mnm '{n!ruin, b
ownership of 10% or more of the outstanding capital stock) in a business.
Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association. l- &-1+
Signature Date
DLLel \e ssa
Printed Name
NOTARY
Swom to (or affirmed) and subscribed before me, by means of LJ physical4presence or LU online
14 h August 20 Rachel Weissman
notarization, this _ day of,2U Y
(City of Miami Beach Board/Committee Member).
X Produced ID
Driver license
Form of Identification
Personaly Known
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Signature of Notary Public O
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
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6° Expires 12/14/2021