Marcella NovelaM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. BC@mjamibeachfl.gov
Telephone: 305.673.7411
HECEIVED
FEB -9 2022
CITY OF MIAMI BEACH
OFFIOF Or FF ITV CLERK
A F F ID A V IT O F A FF IL IA 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):
k{ lam a resident of the City of Miami Beach for six months or longer.
ors woes» 25 \2 Hl an qo Que
o 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 _
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).
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) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
e lare that I have read the foregoing document and that the facts stated in it
Signature
}}arc el la Alovela
Date
Prtd
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o 9nline notarization,
2 2a «Or1022». e4]9 AJouelA
:-~~••"·:~.. CHARLES J. DAGOSTIN
; ¿? MY COMMISSION # HH 16s705
:¿, „¿S EXPIRES: Da 6a n±, 44 8$z.$ U00mer 1,2025
±,j}" Bonded Thru Notary Public Underwriters
Produced ID
i Beach Board/Committee Member). iv loSe
Sig
(NOTARY SEAL)