Max LittMIAMI BEACH
RECEIVED
City of Miami Beach DEC 15 2021
1700 Convention Center Drive
Miami Beach, Florida 33139
CITY C)F MlAM! BEACH
OFFICE OF THE CITY CLERK OFFICE OF THE CITY CLERK
Email: BCC@miamibeachfl.gov
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):
2 1 am a resident of the City of Miami Beach for six months or longer.
Home Address: 6941 Bay Dr, Apt 6C, Miami Beach, FL 33141
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:
❑ 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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
MAX S L_ttt
Signature
Max Litt
Printed Name
December 14, 2021
Date