Steven AdkinsHome Address,
El I have an ownership interest (for a minimum of six months) in to business established in the
City of Miami Beach (for a minimum of six months).
Name of Business:
Business Address:
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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 located in Miami Beach (for a
minimum of six months).
Name of Business: Miami -Dade Gay & Lesbian Chamber of Commerce
Business Address: 1130 Washington Ave. — 1st Floor North; Miami Beach. FL 33139
"Ownership Interest" means the ownership of ton 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 perjury, I declare that I have read the foregoing document and that the facts
stated in it. I la7
Date
Printed Name