Carmen Browne 12/31/221/13/2021
Normandy Shores Lcl Gvmt City Commission
12/31/22 12/31/22
1/21/2021 1/21/2021
1/21/2021
1/21/2021
1/21/2021
21st Jan
A M F f[i [\/i1 i-
i/ M i - H' i
a
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email. C@miamibeachf_gov
Telehoe: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA _ ,
COUNTY OF AGai adz
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
[+íam a resident of the City of Miami Beach for six months or longer.
D 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).
D 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 comp any,
or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
/1/ roo-e
Signature
Cop. boo
/a_/ass
Date 7
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or $ online
notarization, this 1Sf4 January _2o'by
Carmen Browne (City of Miami Beach Board/Committee Member).
FL Drivers License X Produced ID
Form of Identification
Personally Known
Cao, D'qet
Signature of Notary Puig
Charles J D'Agostin
(NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped Charles J. DAgostin
NOTARY PUBLIC ~œ-' ~STATE OF FLORIDA
k -- Comm# GG168171
'-
Expires 12/14/2021
X
Received January 21, 2021Office of the City Clerk