Mark SinnreichMIAMIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC¢@miamibeachfl.gov
Telephone:305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
|am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/)all that apply):
7
a 1am a resident of the City of Miami Beach for six months or longer.
Home Address:223)fishes Lielerd fy ML 83/04
CJ Ihave an ownership interest (for a minimum of six months)in a business established in the
City of Miami Beach (fora minimum of six months).
Name of Business:
Business Address:
01 tamafull-time employee of a business (fora minimum of six months)and |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 (10%)or more (including the
ownership of 10%or more of the outstanding capital stock)ina business.
?Business?means any sole proprietorship,sponsorship,corporation,limited liability company,
or other entity or business association.
Under penalties of perjury,|declarethat |have read the foregoing document and that the facts
(2h [2)
Date
Mik Sinnsecdy w2
Printed Name
Received December 2, 2021
Office of the City Clerk