Alan NiederMIAMI BFACH
RECEIVED
Cityof Miami Beach DEC 01 ZOZI
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY OF MIAMI BEACH
OFFICE OFTHE CITY CLERK OFFICE ()F THE CITY CLERK
Email: 8CO-miarnibeachfi.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (V) all that apply):
am a resident of the City of Miami Beach for six months or longer.
Home Address: /�Iyci
El I have an ownership interest (for a minimum of six months) in a business established in the
Ll(
City of Miami Beach (for a minimum of six months).
Name of Business:
Business Address:
1 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:
Business Address:
"Ownership Interest" means the ownership of ten percent (109/0) or more (including the
ownership of 10°O or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or DVstness association,
Under pen ties of pe
stated in it Am true.
ury, I declare that I have read the foregoing do ' and that the facts
12-Telz1f
Signature T date
Printed Name