Karen Rivo 12312212/31/2026
11/6/2020
11/6/2020
6th Nov
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City of Mi ami each
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.aov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA \ ! ,
couNTY OF flax DA&e
I am in compliance with the affilib
1
. tien requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
Ii íama resident of the City of Miami Beach for six months or longer.
I D I 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).
D I am a full-time employee afia busine;;s (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). I
"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 p>ioprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perjury, I declkre that have read the foregoing document and that the facts
stated in it are trae. . I _ / . / _ KI [ 1L]. z=os
Signature [ r I {go I<i v ]
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or Xonline
l
notarization, this 6th day of lN o y em b e r
I
Karen Rjvo [_ (City of Miami Beach Board/Committee Member).
,2UQ[y_Dy
X Produced ID FL Driver's License
Form of Identification
Personally Known l ·
Ciao. 'A, cut
Signature of Nota_i:y_ F:ub!'F ¡
ostin CharlesJ. D'Ag
(NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
Charles J. DAgostin ç, NOTARY PUBLIC
hs T AT OF FLORIDA
Comm# GG168171
E xpi re s 12 /14 /2 0 2 1
X
Received 6 November 2020Office of the City Clerk