Jamie Laufer 12/31/21City Commission
12/31/21 12/31/26
1/21/2021 1/21/2021
1/21/2021
1/21/2021
1/21/2021
'-' /
'BE f *# · ..
City of Mi ami Be ach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_goy
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
sAr op
COUNTY OF _lade
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check () all that apply):
~ama 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).
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 company,
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.
k lall22a1
Date
h@he La uf
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means ofâ–ˇphysical presence or OConline
notarization, this -day ; January _,20_by
Jam ie Laufer (Ci fMi ·Be :h Bc rd/Cc i ity of liami seact soar/ ommittee Member).
X
Produced ID FL Drivers License
Form of Identification
Personally Known
Cié.o 'ge
Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
1'ka8tLJAgostin
¿ NOTARY PUBLIC
STATE OF FLOR IA
1o t/ comm# GG168171
'>le' Wies° Expires 12/14/2021
X
Received on January 21, 2021Office of the City Clerk