Sorangely Menjivar 12/31/2212/31/22 12/31/22
CITY COMMISSION
1/27/2021
2/1/2021
2/1/2021
2/1/2021
2/1/2021
1 Feb
1A l
City of Miami Beach
1700 Convention Center Drive
Miami each, Florida 33139
OFFICE OF THE CITY CLERK
Email: BQ@mniamibeachf goy
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA y o
COUNTY OF DDd<
I am in compliance with the affiliation requirement of Miami Beach City Code Section s 2-22 (4),
as ( check ( ✓) all that apply):
O I am 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).
~ 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 docum en t an d that the facts
stated in itarè true.
202/
Signature
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of D physical presence or DConline
. lst Febru ary notarization , this day of
Sorangely M enjivar (City of Miami Beach Board/Committee Member ).
20_:_:_by _
X Produced ID
FL Drivers Lice nse
Form of Identification
Personally Kn own
fata o'1et
Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
A8',, Charles J. DAgostin œ NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171 es Expires 12/14/2021
X
Received on February 1, 2021Office of the City Clerk