Betsy Perez 02/28/2202/28/2022 02/28/2022
3/18/2021 2/24/2021
3/18/2021
3/18/2021
3/18/2021
18th Mar
MIAMIBEAC
City of Miamí Beach
1700 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 m11 PL DpG
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply).
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I am a resident of the City of Miami Beach for six months or longer.
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 document and that the facts
stated in it an
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3/1s]a
Date
Printed Na
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of Xphysical presence or D] online
notarization , this löU¡a or March _,20_by
Elizabeth Perez (Cit »f Mi Be :h B rd/Co ·+ Me ber) ity of liami 5eact Soarc ommittee lemher).
X Produced ID FL Drivers License
Form of Identification
Personally Known Cab D'A, +to
Signature of Notary Pu~
(NOTARY SEAL)
Charles]. D'Agostin
Name of Notary, Typed, Printed, or Stamped
Charles J. DAgostin
NOTARY PUBLIC
sTATE o FLORIA
;7 Comm# GG168171
Expires 12/14/2021
X
Received March 18, 2021Office of the City Clerk