Bruce Carter 12/31/231/13/2021
City Commission
12/31/23 12/31/23
1/20/2021 1/20/2021
1/24/2021
1/25/2021
1/25/2021
24 Jan
MIA MAI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibcachi_go
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
sTATE or FORI ),3,
couNT o [D .A - vv
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply).
~a resident of the City of Miami Beach for six months or longer.
[] {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).
[] lam 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
E # l).. 1,2./
9ga5° - n ... Date
b o > ATe
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or X online
notarization, u, 24tb, r Jan uary
Bruce Carter (City of Miami Beach Board/Committee Member).
FL Drivers License
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X Produced ID
Form of Identification
. 3Personally Known Cuaslea D'A, ut,
soareoay en.„'
Chales.»,p2,'gg$7 Name öt diary, ypeu, 'rniêo, or Stamped
(NOTARY SEAL)
1A!a,, Charles J. DAgostin
il) NOTARY PUBLIC
3 2 [STATE OF FLORIDA
Comm# GG168171
<ve l Ts" Expires 12/14/2021
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Received on January 24, 2021Office of the City Clerk