Lee Zimmerman 12/31/222/1/2021
12/31/22 12/31/25
2/1/2021 1/28/2021
2/23/2021
2/23/2021
2/23/2021
2/23/2021
Received on February 23,2021Office of the City Clerk
A
V A V BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF Miami-Dade
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
ci I am a resident of the City of Miami Beach for six months or longer.
~ave an ownership interest (for a minimum of six months) in a business established in the JitSì of Miami Beach (for a minimum of six months).
[] 1am 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).
"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. 2= 2-23-2zl
Signature ),
/( /lt+tt
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O{ physical presence orâ–¡online
notarization, this 23rdday or February ,201_by
Lee Zimmerman (City of Miami Beach Board/Committee Member).
_k_ Produced ID FL Driver'sLicense
Form of Identification
Personally Known
'au ?'get
Signature of Notary Public
Charles J D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
Charles J. DAgostin
¿, NOTARY PUBLIC
hl ÉsAr o FLORIDA
lW/ comm# GG166171
Expires 12/14/2021
X
Received on Feb 23, 2021Office of the City Clerk