Dan Nagler 12/31/223/17/2021
City Commission
12/31/22 12/31/26
3/18/2021 2/20/2021
3/24/2021
3/24/2021
3/24/2021
Received March 24, 2021Office of the City Clerk
20th Mar
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. BC@mniamibeachf_gov
Telephon e: 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):
[í„+ 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
" L ±r-lezi
Signature~ :\I Date
D o e /Acee
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ro physical presence or o online
notarization, this 2th3day r March _,201_by
Daniel Nagler (City of Miami Beach Board/Committee Member).
X Produced ID FL Driver's License
Form of Identification
Personally Known Ciao tv'get
Sigpat ge,g atapy,P4ple Charles D'Agostun
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
Charles J. DAgostin yr 3, NOTARY PUBLIC
ä : STATE OF FLORIDA
? Comm# GG168171 : {g
TS" Expires 12/14/2021
X
Received March 24, 2021Office of the City Clerk