Laurie Kaye Davis 12/31/21Laurie Kaye Davis 11/03/2020
MB Commission for Women Mayor Dan Gelber
12/31/21 12/31/21
11/06/2020 11/06/2020
11/06/2020
11/06/2020
11/06/2020
6th Nov
Ci ty of Miami Beach
1700 Convention Center Drive
Miari each, Florida 33139
OFFICE OF THE CITY CLERK
Email: EC@miamibeach@_go
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
I\.A ' D·. -~ fl COUNTY OF po _to-t
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
✓iam a 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).
[] lama 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
stated in it are true.
¿, • • Za A,<d ? ct 1ar gnature 4
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Date
dc€ k..y U r>
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of [ physical presence or K online
notarization, this 6th day of November
Laurie Kaye Davis (City of Miami Beach Board/Committee Member).
X Produced ID FL Driver's License
Form of Identification
Personally Known
Ciao. D'get
,2Uy9_Dy
Signature of Notary PuÉfic
Charles J. D'Aqostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
o2!&s, Shares J. DAgosti .go NOTARY PUBLIC
t " s TAT or FLORIDA
l:7 comm# GG168171
Expires 12/14/2021
X
Received 6 November 2020Office of the City Clerk