Seth Feuer 12/31/2212/31/22 12/31/25
1/8/2021 1/8/2021
1/8/2021
1/8/2021
1/8/2021
8th Jan
e -/
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. C @mniamibeach fl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA .
COUNTY OF Hai - Eade
I am in compliance with the affiliation requirement of Miami Beach City Cod e Sections 2-22 (4),
as (check(✓) all that apply):
~ am 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).
D I am 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 loca ted 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
&~-te···d····.· 1. r true._
,n < > (-2?l
Sí@ature Date
5rl •
Printed Name
NOTARY
Sworn to (or affirmed} and subscribed before me, by mean s of phy sical presence or Kl online
notarization, this th day of January _,2021_by
Seth Feuer (City of Miami Beach Board/Committee Member).
X Produced ID FL Drivers License
Form of Identification
Personally Known
Ciao, 'A, nt
Signat ure of Notary Pugt¿
Charles JD'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
1M'a,, Charles J. DAgostin
®NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
e5G pi res 12/14/2021
X
Received on January 8, 2021Office of the City Clerk