Rosary Falero 12/31/2212/31/22 12/31/25
1/12/2021 1/12/2021
1/12/2021
1/16/2021
1/16/2021
1/20/2021
16th Jan
MI A M/BEACH
City of Miami Bea ch
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emai l. SC@m iamibeacnf go
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
e=rqg; 2ade cour or Lu.G
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
ef I am a resident of the City of Miami Beach for six months or longer.
O 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).
O 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. --
kart fi0 Ee Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or [X online
notarization, this _1o day or Jan uary
Rosary Falero (City of Miami Beach Board/Committee Member).
,20~by ..
X Produced ID FL Drivers License
Form of Identification
,Personaly Known
asa o'get
Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL}
',, Charles J. DAgostin œ.r, NOTARY PUBLIC
2E STATE OF FLORIDA
Comm# GG168171
e pires 12/14/2021
X
Received on January 16, 2021Office of the City Clerk