Tim Carr 12/31/2212/31/22 12/31/28
3/19/2021 3/16/2021
3/19/2021
3/19/2021
3/19/2021
Received on March 19, 2021Office of the City Clerk
MIAMIBE ACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA -
cour or L i D2pC
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) al l that apply):
~I am 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 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
"E ¿. zo
Signature Date z
IL Cat
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of [X physical presence orâ–¡online
notarization, this lhday or arch _, 20_by
Tim Carr ________________ (City of Miami Beach Board/Committee Member).
X Produced ID
FL Drivers License
Form of Identification
Personally Known
la DA, ct
son are or e ,i éfsí
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
l)Charles J. DAgostin
i NOTARY PUBLIC
g' EsTATE OF FLORIDA
Comm# GG168171 f° xpires 12/14/2021
X
Received March 19, 2021Office of the City Clerk