Edward KringM IA M IB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 23 2022
CITY OF MIAMI BEACH
OFFICE OE THE CITY CL E RK
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):
r£ I am a resident of the City of Miami Beach for six months or longer.
Home Address __ 1_5_0_4_B_a_y_R_o_a_d_, _U_n_it_1_8_0_7_M_i_a_m_i _B_e_ac_h_,_F_L_3_3_1_3_9 _
o 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 _
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).
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 ·" f ß]; us.s.zsz,
Signature Date
Edward Martí Kring
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of~ysical P.resence or o online notarization,
.9a.Joie7 22_Eda Ka
(City of MD Beach Board/Committeé Member)
fZ. ucr eo Se Produced ID
Form of Identification
tonally Known
l ] ls;¿g, CHARLES ), DA pf/AR
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