Carlos Gutierrez1/A\Ml B H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
DEC 1 7 2021
CITY OF MIAMI BEACH
OFFICE OE 4E CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
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):
o I am a resident of the City of Miami Beach for six months or longer.
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fil" 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 Coldwell Banker Realty_- Gutierrez Group/G Group
Business Address 1682 Jefferson Avenue Miami Beach, Florida 33139
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).
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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 so/e proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
I declare that I have read the foregoing document and that the facts stated in it
December 16, 2021
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or o online notarization,
this 16 day of December , 20_21_by Carlos Gutierrez
_________ (City of Miami Beach Board/Committee Member).
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Produced ID
Form of Identification
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Siguaty é of Notary Public
Ell . Berkman
Name of Notary, Typed, Printed, or Stamped