Gaby Baglietto 12/31/22City CommissionSenior Affairs Committee
12/31/22 12/31/24
2/13/2021 1/28/2021
5/20/2021
Digitally Signed/GB
05/20/2021
05/20/2021
Received May 20, 2021Office of the City Clerk
1AI
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 OE AEFILIATION WITH THE CITY OE MIAMI BEACH
STATE OF FLORIDA
COUNTY OF _AL BA [Ly 2.Dé
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply): " oo "
p] 1am 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).
[] lam 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. no
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
srat~· '- A5]go]c2/
Signature' .. Date 7 1
Ay pLTTo
Printed Name
NOTARY
.
Sworn to (or affirmed) and subscribed before me, by means of [}physical presence or LT; online
notarization, this_?Oh day r May " _,20_by
• Gaby Baglietto
_(City of Miami Beach Board/Committee Member).
X Produced ID
FL Drivers License
Form of Identification
Personally Known
Caal, D'Aaect
Signature of Notary Pie
Charles ,J D'Agostin
{NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
1!g,, Charles J. DAgostin œ.r. NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
Pk % "E s" Expires 12/14/2021
X
Received May 20, 2021
Office of the City Clerk