Alan Fishman 12/31/2212/31/22 12/31/24
1/21/2021 1/21/2021
1/21/2021
1/21/2021
1/21/2021
1/21/2021
21st Jan
City of Miami Beach
17O0 ore±on Ceone Dive
Miami Beach fl,da 3313
OFFICE OF THE CITY CLERK
Emal BC_gmuam.beach go
305 73 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY or DA1-DC
l am mn compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check () all that apply).
Ki am a resident of the City oí Miami Beach for six months or longer.
%1 have an ownership interest (for a minimum of six months) in a business established in the
C ity of Miami Beach (for a mmnmmum of six months).
[] 1am a full-tmme employee of a business (for a minimum of sx months) and 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, muted liability company
or other entity or business association
Under penalties of perjury, I declare that l have read the foregoing document and that the facts
sta,ed;n,taretr~ ·. \ . \ ·~··· , .
L Z e2y
Signature_ ' Date
[o >rvf,o»
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ù physical presence or X online
notarization, thu s 21stday ot January l[y
Alan Bruce Fishman (City of Miami Beach Board/Committee Member)
X Produced ID FL Drivers License
Form of Identification
5,P er s 9al ly Known
ha D ', atza
Sígnß\ure .of Notary Pub{!:,,
Charles J D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL )
ta, Charles J. DAgost i
NOTARY PUBLIC
STATE OF FLORIDA '<± c omm # GG163171
Expires 12/14/2021
X
Received on January 21, 2021Office of the City Clerk