Amy Rabin 12/31/21Amy Rabin 12/31/2020
TPBPFC Commissioner Meiner
12/31/2020 12/20/2020
12/31/2020
12/31/2020
12/31/2020
31 Dec
City of Miami Beach
1700 Convention C enter Drive
Miami Besch, Florida. 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeach fl.gay
Telephon e. 305.673.7411
AFFIDATI QF_AFFILLATIQN WITH THE çIIQF MALAMA BEACH
STATE OF FLORIDA
COUNTY OF
1 am in compliance with the affil iation requirement of Miami Beach City Code Sections 2-22 (4),
as {check (/) all that apply):
[]íam a resident of the City of Miam i Beach for six months or longer.
[] thave an ownership interest (for a minimum of six months) in a busine ss established in the
City of Miami Beach (for a minimum of six months).
[ tam 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, corpor ation, 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
12/a1/z
Signatufe
=a.e¥ fa io
Date
NOTARY
Sworn to {or affirmed) and subscribed before me, by means of DJ physical presence or D online
notarization, this 'l day of December
Amy Rabin (City of Miami each Board/Committee Member).
,20"_by
X Produced ID FL Drivers License
Form of Identification
Personally Known
Cao. D'aeon,
Signature of Notary PEfe
Charle s J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
N!a, Charles J. DAgostin œNOTARY PUBLIC
st STATE OF FLORIDA
Comm# GG168171
í poires 12/14/2021
X
Received 31 Dec 2020
Office of the City
Clerk