Lauren CantorY ram a resident of the-city of Miami Beach for six months or ronger,
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MIAMIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl .qov
Telephone: 305.673.741 1
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):
Business Address:
n I am a fulltime 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 lnterest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) rn a busrness.
"Busmess" means any so/e proprietorship, sponsorshlp, corporation, limited liability
company, or other entity or business association.
have read the foregoing document and that the facts
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F-' 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:
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Date
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Under penalties of perjury, I declare that I
stated in,rfhre true.
= l,,arren Cnr^t "rPrinted Name
Received December 8, 2021
Office of the City Clerk