Mary Keinath 12/31/221/23/2021
Commissioner Samuelian
12/31/22 12/31/25
1/23/2021 1/23/2021
1/25/2021
1/25/2021
1/25/2021
25th Jan
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IAMIBEACH
City oé Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF TH E CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.741l
AFFIDAVIT QF_AFFILIAI1QN yIH THE IIQFMIAMI BEACH
STATE OF FLORIDA
COUNTY )E
l am in compliance with the affiliation requirement of Miami Beach City Code Secti on s 2-22 (4),
as (check () all that apply): a 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 otherentity or business association.
Undeif perj~lties f ir/ry, I 1eclare that I have read the foregoing document and that the facts
retel. 1l5/24
l bi = " ca.l!%p he+h
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NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O physical presence or d online
notarization, this "day of January _,2021b y
Mary Keinath (City of Miami Beach Board/Committee Member).
FL Drivers License X Produced ID
Form of Identification
,, Persopaly Known
boa D'A ut, ele#e» asa-
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
1AR!a, Charles J. DAgostin œ4:, ~ NOTARY PUBLIC
23]. STATE OF FLORIDA
2 :i Comm# GG168171 '¢ .+a°
7TS3 Expires 12/14/2021
X
Received on January 25, 2021
Office of the City Clerk