Martin Zaiac 12/31/241/13/2021
Martin Zaiac
Health Facilities Authority Board
City Commission
12/31/2024 No Term Limit
1/13/2021 1/13/2021
1/13/2021
1/19/2021
1/19/2021
MI A M/BE A CH
City of Miam i Beach
1700 Convention Center Drive
Miami Beach, Flor id 33139
OFFICE OF THE CITY CLERK
Email: C @ mi am i be achfl.gov
Telephone: 305.673.741 l
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST A TE OF FLORIDA
COUNTY OF
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
D 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).
"E 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 anysole proprietorship, sponsorship, corporation, limited liability company,
or other entity or,busing$s association.
h ve
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or online
oarzato, mns !2_ aa r ]/A y¿]l L _2o2 y
Martin Zaiac J Q (City of Miami Beach Board/Committee Member).
FL Drivers License X Produced ID
declare that I have read the foregoing document and that the facts ,
Date
Form of Identification
LU_ Personally Known
Ciaoi'get
Signa ture of Notary_ Public
Charles JD'Agostin
Name of Notary, Typed, Printed, or Stamped
7
(NOTARY SEAL)
Charles J . DAgostin
N O TA R Y P U B LI C
S T A T E OF FLOR ID A ct com m # GG168171
Expires 12/14/2021
X
Received on January 19, 2021
Office of the City Clerk