Yoshaun Pastrana 12/31/221
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C ity o f M iam i B e a ch
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLQR[DA . .- cour oF ß„eau 40€
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
/
[] lam 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).
~ma 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.
ry, l declare that l have read the foregoing document and that the facts
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3e414/2zz
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of LX physical presence or O online
. 17th, June 2021 PO[a/Za[ion, [l[IS (d\/ O '}
Yoshaun Pastrana (City, f Mi ·B ·h B rd/Cc itte Me ber) fy o1 am ieacl oar ommtee em er .
X Produced ID FL Drivers License
Form of Identification
Persgnally 'nown
"ge Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
fl)/>.RY Charles • DAgostin
NOTARY PUBLIC
g ·STATE OF FLORIDA
Comm# GG168171
% '+6 Tc19' Expires 12/14/2021