Michael McManus>,
RECEIVED
1
BEACH
DEC 06 2021
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY OF: M, IAMI BEACH
oF,n'GF'or-' TME CITY CLERK
OFFICE OF THE CITY CLERK
Email: [,3C'�iamibeachfi.ov
—telephone: 305.673,7411
AFFIDAVIT OF AFFILIATION WITH THE 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):
am a resident of the City of Miami Beach for six months or longer.
Nome Address.1,
0 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:
El 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 (10%) or more (including the
ownership of 10°%0 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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
Signature
> f1t1'.
Printed Name
Date