Hagai Gringarten 12/31/2212/21/2020
12/31/22 12/31/28
12/21/2020 12/31/2020
12/31/2020
12/21/2020
12/21/2020
12/21/2020
MI A MI BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check (/) all that apply):
~ a resident of the City of Miami Beach for six months or longer.
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).
[] lam a full-time employee of a business (for a minimum of six months) an d l 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
"\_L._Z Jg.A
Signature ~ e; -D-a-te _
EE Hn± KIGA-I-
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O physical presence or !i<! online
· 21 December notarization, this day of
Hagai Gringarten (City of Miami Beach Board/Committee Member).
.212/3%2029
X Produced ID FL Drivers License
Form of Identification
Personally Known
Ciao, D'A, sut
Signature of Notary Pubf
Charles J D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
Au',, Charles J. DAgostin
'.'<C~.rq, NOTARY PUBLIC
g¥'-„ sAr or FLORIDA
2k -:i Comm GG168171 ' ' 6 Expires 12/14/2021