Peter Matos 12/31/221
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MIAMIBEAC
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf]_gov
Telephone: 305.673 .7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF Miami-Dade
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
• resident of the City of Miami Beach for six months or longer.
~-;· have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
O I am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
s-tate_d·i-~-e-··tr _ . . . ~- -_-- _ ---_- , = ff- $_?0 20
Si@n ature = Date
P...- /afes
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or t3online
notarization, th¡ 'hay or November _, 20_2by
Peter Matos (City of Miami Beach Board/Committee Member).
X Produced ID
FL Driver's License
Form of Identification
Personally Known
(Cao. 'A, ut
Signature, of Notary Pu~
Charles J D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
Charles J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
ki. Comm# GG168171
Expires 12/14/2021
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