Lourdes OrozaM IAN\IBEA H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
RECEIVED
FEB -7 2022
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411 CITY OF MIAMI BE
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AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH LEAK
S T A T E O F F L O R ID A
C O U N T Y O F M IA M I-D A D E
I am in co m p lia nce w ith the aff ilia tio n req u ire m e nt of M ia m i B e ac h C ity C o d e S e ction s 2-22 (4 ), as (che c k
(/) all tha t ap p ly ):
✓I am a resid e nt of the C ity of M ia m i B e a ch for six m o nths or lo ng e r.
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o I h ave a n ow ne rship inte re st (for a m in im u m of six m o nths) in a busin e ss esta b lishe d in the C ity of
M ia m i B e a ch (for a m in im u m of six m o nths).
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o I am a full-tim e em p lo ye e of a busin e ss (fo r a m in im u m of six m o nths) and I am based in an off ice o r
othe r lo ca tio n of the bus ine ss tha t is physica lly lo cate d in M ia m i B e ach (fo r a m in im um of six m o n ths).
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"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.
are th at I h a ve rea d th e fore goi ng do cum en t an d th at,th e fact s stat e d in it
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P rinte d N a m e
N O T A R Y
Sworn to (or affirmed) ap d sub s cr ibe d be fo re m e, ¡m eans oÌ~~ysi:"I pre sence or o online notarization,
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(City of M¡;· i B e a ch B o ar d /C om m i tt ee M em b er ).
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%3; ¿é EXPIRES: December 14, 2025
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