Herb Sosa 12312212/31/22 12/31/24
1/1/2021 1/1/2021
1/13/2021
1/13/2021
1/13/2021
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CL ERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA CH
STATE OF FLORIDA
COUNTY OF Miami Dade
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check (/) all that apply):
IZJ I am a resident of the City of Miami Beach for six months or longer.
IX1 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).
Ix] 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 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
stated in it are true.d
f January 13, 2021
Hl f/
Heriberto J Sosa Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or on line
notarization, this I3thday of January ,20'_b y
Heriberto J. Sosa (City of Miami Beach Board/Committee Member).
Charles J. DAgostin
2 NOTARY PUBLIC I STATE OF FLOR IDA
'k--ls comm GG168171
Expires 12/14/2021
X Produced ID FL Drivers License
Form of Identification
Personally Known
Ciao, '1get
Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
NO TAY.SF Al}..a
i±, NOTARY PUBLIC
, 'STATE OF FLORIDA
.>omm# GG168171
'
" pires 12/14/2021
l.1ear t-rom t"rmt t-orm MIAMI-DADE. gm SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st of every year.
Disclosure for Tax Year Ending I Last Name First Name Middle Name/Initial
2020 Sosa Heriberto
Mailing Address -Street Number, Street Name, or P.O. Box
831 9th Street City, State, Zip
Miami Beach, Fl 33139
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. D
Filing as an Employee (check one)
□County □ Public Health Trust D Municipal: (Municipality) Department
Position or Title Employee ID Number
J
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County IZI Municipal: Miami Beacb (Municipality) Board where serving
LGBT Advisroy Board Alternate address (if home address is exempt)
n/a I Work telephone
786-271-6982 I Term began on/ended on
Jan 1, 2021-Dec 31,2
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.□ Name of Source of Income Address Description of the Principal Business Activity
Rental Property Owner 829 9th Street, Miami Beach Property Management
I hereby swear (or affirm) that the information above is a true and correct statement.
s;g•atu,o ofP,rao• D;solo.4 '
RECEIVED BY ELECTIONS DEPARTME NT:
D Hardcopy
DX Electronic Copy
January 13, 2021
Date signed
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
Received January 13, 2021
Office of the City Clerk