Marvena Mitchell 06/30/22MB South Pointe PTA
Marvena Mitchell
Committee for Quality Education
8/10/2021
06/30/2022 06/30/2022
8/10/2021 8/10/2021
8/16/2021
08/16/2021
08/16/2021
08/16/2021
Received August 18, 2021
Office of the City Clerk
MIAMI BEACH
City of Miami Beach
1700 Convention Cenle-r D,i..,o
M;om; Ele<>ch, Flo,;do 33139
OFFICE OF lliE CITY CL ERK
Ems,I: BC:6'miamibeachn .aov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFJLIAT fON WITH THE ClTY 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):
� I am a resident of the City of Miami Beach for six months or longer.
D I have an ownership interest (for a minimum of si x months) in a business established in the
City of Mi,imi Be,ich (for a minimum of six months).
0 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 localed in Miami Beach (for a
minimum of six months).
"Ol'✓nership Interest' means the ownership of ten percent (10%) or more (including the
owners/lip of 10% or more of the outstanding capital stock) in a business.
'Business• means any sole proprietors/lip, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalti es of perjury. I declare that I have re,id the foregoi ng document and that the facts
stated in it are true.
�]¥Wk .41clvv s1gaiure
frJarWnA m, �c .4 /1
Printed Name
NOTARY
"f //(,.,I :Jo2 1Date '
Sworn to (or affirmed) and subscribed before me, by means of El physica l presence or □ online
notarization, this __ day of ________ , 20 __ by ___________ _
________________ (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Personally Known
(NOTARY SEAL)
Signature of Notary Public
Name of Notary, Typed. Printed. or Stamped
X
16th April 21
Marvena Mitchell
X FL Drivers License
Charles J. D'Agostin
X City of Miami Beach
Committee for Quality Education in Miami Beach
08/2021
X
Received August 18, 2021
Office of the City Clerk