Gino Santorio 12/31/22Gino Santorio
Health Advisory Committee City Commission
12/31/2022 12/31/2026
1/20/2021
1/20/2021 12/17/2020
3/29/2021
3/29/2021
3/29/2021
Received on March 29,2021
Office of the City Clerk
29th Mar
M l BEACH
City of Miami Beach
700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC @m i ami be ach f _gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA .
C O U N TY Op M iam i -D a d e
I am in com plia nce w ith the affi liation requírem ent of M iam i B each C ity C ode Section s 2-22 (4),
as (ch eck () all th at apply):
[] tam a re si d en t of th e C ity of Miami B each for six m onth s or long er .
[] th ave a n own er sh ip intere st (for a m inim um of six m onths ) in a busi ness est ablish ed in th e
/ City of M ia m i B each (fo r a m inim um of six m on th s).
[] 1a m a ful l-time emp l oyee of a busine ss (for a m inim um of si x m onth s) an d l am based in an
offi ce o r oth er location of the business that is physically located in M iam i. Beach (for a
mi n im um o f si x m onth s).
"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.
U n de r pe nalties of perjury, I decl ar e that I have read the fo regoing docum ent and that the fa cts
state d in it a re tr ue .
• A d>,g> 3/8laca
S ign a ture Date
S A 5 e@ l¢
P rin ted N a m e
N O TA R Y
S w o rn to (or affi rm e d) and sub scribe d before m e, by m eans of physical pre sen ce or l onlin e
no tarization , thi 1ó4y or March ,21_by
Gino Santorio (C ity of M iam i B each B oard/C om m ittee M em ber).
X P ro du ce d ID FL Driver's License
Form of Iden tifi cation
P e rs onally K now n
ala Z'Aaatze
Signature of Notary Pubi
Charles J D'Agostin
(N O TAR Y SEAL )
N am e of N o tary, Typed, Printed, or Stamped
A8',, Charles J. DAgostin
@ NOTARY PUBLIC
Fl STATE OF FLORIDA
Comm# GG168171
Pio Expires 12/14/2021
X
Received March 29, 2021Office of the City Clerk