Martin ZaiacMIAMI BEACH RECEIVED
City of Miami Beach DEC 0 1 2021
1700 Convention Center Drive
Miami Beach, Florida 33139
CITY OF MIAMI 13 -EACH
OFFICE OF THE CITY CLERK OFFICE OF THE CITY CLERK
Email: �&mjamW.,QaQb&W?y
Telephone: 305.673.7411
AFFIDAVIT OF AFEILIATION WITM THt_C1TY_0_E_M1AM_1H
I am in compliance with the affiliation requirement of Miami Beach City Code Sections
as (check (,/) all that apply):
I am a resident of the City of Miami Beach for six months or longer.
bme Address:
have an ownership interest (for a minimum of six months) in a business establish(
City of Miami Beach (for a mini um of six onths).
Name of Business:
Iness Address:
I am a full-time employee of a business (for a minimum of six months) and I am ba:
office or other location of the business that is physically located in Miami Bea(
minimum of six months).
Name of Business:
Business Add
"Ownership Interest" means the ownership of ten percent (10%) or more (including ti
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" m7r proprietorship, sponsorship, corporation, limited liab"11.
company, siness association,
om any, or, gtn 6- yVlor ;�u,,
Under declare that I have read the foregoing document at th
stated '7 1 12,7
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