Cameron McLain 12/31/2112/31/21 12/31/22
5/20/2021 5/7/2021
6/2/2021
6/2/2021
6/2/2021
Received June 2, 2021Office of the City Clerk
il IBEAC
City of Miami Beach
170 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email g@muamipechf goy
Telephone: 305673.7411
AFFIDAVIT OF AEELL IA TION WITH THE CITY OF MIA ML BEA CH
ST ATE OF FLORIDA
COUNTY OF kl[hi Dade
I I
à
i 3 I
I 3 1 I
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply).
[] tam a resident of the City of Miami Beach for six months or longer.
[] thave 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).
[ 1am 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 are true.
Ce.Pe. Gol2/24
Signature
Camero n MLon
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of X physical presence or D] online
notarization, this Znd_day of June 20l_by
Cameron McLain _(City of Miami Beach Board/Committee Member).
FL Driver's License X Produced ID
Form of Identification
Personally Known
aloa D'A ·uta
soue or.,,,, 'f + f Notary Public
Charles J D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
Charles J. DAgostin
Z¿ NOTARY PUBLIC
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e pires 12/14/2021
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Received June 2, 2021Office of the City Clerk