Curtis Slipman/\AIAI BEACH
RECEIVED
City of Miami Beach
DEC 01 2021
1700 Convention Center Drive
Miami Beach, Florida 33139 CIT`(OF MIAMI BEACH
OFFICE OF THE CITY CLERK OFFICE OF THE CITY CLERK
Email: B—G.&miamibeachfE Dov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH TjjE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (✓) all that apply):
X I am a resident of the City of Miami Beach for six months or longer.
Home Address: 1455 Ocean Drive, 710
❑ 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).
Name of Business:
Business Address.
❑ 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:
Business Address:
"Ownership Interest" means the ownership of ten percent (1091o) 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
cotppany, or other entity or business association.
Un erl enalti f`perju , I declare that I have read the foregoing document and that the facts
state( [[n it1 e true.
December 1, 2021
Sinat Date
Cu is lip
Prince • 'me