Carmen Browne 12/31/222/10/2021
City Commission
12/31/22 12/31/26
2/11/2021 2/6/2021
2/11/2021
2/11/2021
2/11/2021
/~V1 I Ä /\¡\¡· BEACH luz i 1 .4
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 741 1
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
srATE o FLORIDA' A
COUNTY OF\\1À-. '0€
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
[Dí 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).
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.
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Printed Name
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Date 7 7
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or l}!1 online
notarization, this 11th day of February_ _,201_by
Carmen M. Browne (City of Miami Beach Board/Committee Member).
X Produced ID FL Drivers License
Form of Identification
Personally Known
Caaba D'pet
Signature of Notary PuBiWE
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
Charles J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
Nell Comm# GG168171
Expires 12/14/2021
X
Received February 11, 2021Office of the City Clerk