Jeff Lehman 12/31/221/13/2021
City Commission
12/31/21 12/31/21
1/20/2021 1/20/2021
2/1/2021
2/1/2021
2/1/2021
31st Jan
EACH
City of Miami Beach
170 Cover#ion Cete: rive
Micm i e ach, Flr ido 33139
O FFIC E OF THE CITY CL ERK
Emal B@miamibeachil aov
Telephone : 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF M iam i-Dade
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
[] 1am aresident 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 mínimum of six months).
X l am a full-time employee of a business (for a minimum of six months) and l am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
O wne rsh ip Interest" m e ans th e own ership of ten percent (10%) or m ore (incl uding the
ownership of 10% or m o re of th e outstanding capital stock) in a business.
B u sin ess" m e an s any sole p ro p rietorship, sponsorship, corp oration, lim ited liability com pany,
or other en tity or bu sin e ss association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
state~ ar;)~
[/ou
Signatule Date
_her euro)
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before m e, by m ean s of [ physical presence or X oniine
notarization, this 31st4ay or January 2021_by
Jeff Lehm an (City of Miami Beach Board/Committee Member).
X Produced ID FL Drivers License
Form of identification
Personally Known
Ccoba D'acote
Signature of Noia, Rufe
charles ± P'#gg stn Name öf' löt~ry. 'y} ?S Inted, or Stamped
(NOTARY SEAL )
Ya,_ Charles J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
T6" Expires 12/14/2021
X
Received on January 31, 2021
Office of the City Clerk