Sandra MartinMI A\MIBEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 11 2022
CITY OF MIAMI BEACH
O FF IC E O F TH E C ITY C LER K
A F F ID A V IT O F A F F ILI A T IO N W IT H T H E C IT Y O F M IA M I B E A C H
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(✓) all that apply):
Cli' I am a resident of the City of Miami Beach for six months or longer.
Home Address 5701 COLLINS AVE APT 410 MIAMI BEACH FL 33140
l;ï! 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 ESTRELLA INSURANCE
Business Address 1321 AL TON RD MIAMI BEACH El 33139
o 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).
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"Ownership Interest" means the ownership 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, sponsorship, corporation, limited liability company, or other
entity or business association.
eclare that l,have read the foregoing document and that the facts stated in it
V 02/11/2022 te
Date Signature
Sandra Martin
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of~;ysical presen~line notarization,
» /Las/e9e as22, ulì4e /ig
(City of Miami Beach Board/Committee Member).
@ iu?_s L_rese Produced ID
Form of Identification
anally Known
Sig
(NOTARY SEAL)
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%¿,lg&a.¿gi ExPREs: Decomber 14, 2025
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