Carmen DatorreBEACH
City of Miami South
1700 Cckny�,,,oliorl CenlerDflivo
&A ". 0 rn i L� C 0 C P , `I w' i c1h, Q 33 m !f 3 9
OFFICE OF THE CITY CLERK
Email: fiL
Telepor* 305 673 ;411
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DEC 1.7 2021
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6 01Z rHc- C/Ty CLERK
AFFIDAVIT OF AFFILIATION WIT I THE CITY QE MIAMI BEACH
I am iornpliance with the affiliation requirement of KliarrBeach 0,,ty Code Sections 2.22 (4),
asall that apply)-
v ta resident of the City of Miami Beach for &x months or longer.
Home ddrew L
0/1 have an ownership interest (for a min.,imum of s.lix months) n a' business cstabltshed--, :n th e
pity of Miami Beach (for a minimum of six months).
Name of Bus nbss.
Business Address: .'� ✓/� :'"'1 35 /-5
I am a run-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the b,usiiriess that is physically located in Miami Beach for a
minimum of six months).
Name of
5 -
Business Address:- . .......
331
"Ownership Interest" means the ownership of ton percent �10%.) or more (including the
ownership of 10% or mare of the outstar?6nq capfta�l stock) in a business.
'Business " means any sole proprietarship, sponsotshop, corporation, hinited fiabdity cornpany.
or other entily or business assn ctation.
Undo, r. penalties of perjury, I
statkin ota're true.
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Printed Name
that I have read the foregoing document and that, the tat-ts
Date