David Berger 12/31/2212/30/2020
12/31/22 12/31/25
12/30/2020 12/30/2020
12/30/2020
1/4/2021
1/4/2021
4th 1Jan
- ~
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Flrid 33139
OFFICE OF THE CITY CLER K
Email: C@miamnibegachi]_goy
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MI! 9p€
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
} 1am 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).
[] 1am a full-time employee of a business (for a minimum of six months) and 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
own ership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sp onsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perjury, I declare that l have read the foregoing document and that the facts
stated in it are true
5l l~
Signature ()
David Be4 e
3
lel z
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or online
• o tu 4th4. January 2 2?l, P[a[fZ@[}f7 ¡li d Ol ' -
David Berger (City of Miami Beach Board/Committee Member).
X Produced ID FL Drivers License
Form of Identification
Personally Known
Co.2 'get
Signature of Notary Publiè
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
Charles J. DAgostin
¿ NOTARY PUBLIC
ÉsTATE OF FLOR IDA
3ER 165l; ' Comm# GG168171
8e Expires 12/14/2021
X
Received January 4, 2021Office of the City Clerk