Carolina JonesCity of Miami Bea ch
700 Convetin Cet Drivc
M ia m i each, florda 33139
OFFICE OF THE STY CLERK
Email: 3g@riamibeachf .go
Telephon e: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in complian ce with the affiliation requirement of Miami Beach City Code Sections 2-22 (4). as (check
(/) all that apply):
r lam a resident of the City of Miami Beach for six months or longer.
a 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).
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lam a full-time employee of a business (for a minimum ot six months) and l am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six mont hs)
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"Ownership interest" means the owne rship 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, spo nsorship, 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. [},,1-
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[ Signature
Printed Name
NOTARY
.(City of Miami Brach Board/Committee Member) · ye<e
Name of Notary, Typed, Printed, or Stamped
(NOTAR Y SEAL )
gif¿, CHARLES J. DAGO STNN $$";; c ou ssioN # HH 16s7os
$,9%.5; ExPIREs: Decem ber 14, 2025 "íj ?" Bonded Thru Notary Pub lic Und erwrit er s