Raquel Pacheco 12/31/22Raquel Pacheco 1/13/2021
Personnel Board City Commission
12/31/22 12/31/24
1/21/2021 1/21/2021
1/21/2021
1/21/2021
1/21/2021
21st Jan
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: EC@maiamibeachf7.gov
Teleph on e: 305.6 73.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLOR IDA •
COUNTY OF EiAii_a·lg
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check () all that apply):
✓iam 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 own ersh ip of ten perce nt (10%) or more (including the
ownership of 10% or more of the outstanding capital stoc k) in a business.
"Business" m eans any sole proprietorship, spon sorsh ip, corporation, limited liability co mp 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.
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Sig, fre
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2s uet st z
Tint A1 >
Date ' t
,·«'éd Name
NOTARY
Sworn to (or affirm ed) and subscribe d before me, by mean s of [ physical presence or K online
notarization, this 21stay of _ January
Raguel Pacheco (City of Miami Beach Board/Com mittee Member).
2O_ll by
X Produced ID FL Drivers License
Fo rm of Identification
P er s on a lly K nown
Caoba Z'aeuto
Signat ure of Notary Püi
Chares JD'Agosti
Name of Notary, Typ ed,
(NOT ARY SEAL)
1A!o,, Charles J. DAgostin œ:.r. NOTARY PUBLIC
gg ¿STATE OF FLORIDA
Comm# GG168171 e° oires 12/14/2021
1 I
X
Received on January 21, 2021Office of the City Clerk