Laura CadoretteMIAM/BEACH
City of Miami Beach
1700 Convention Center Drive
M iom i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@ miamibeachfl.gov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STA T E OF FLO R IDA
C O UNT Y O F M IAM I-DADE
I am in compliance w ith the affi liation requirem ent of M iam i Beach City C ode Section s 2-22 (4), as (check
all that apply):
I am a resident of the City of M iam i Beach for six m onths or longer.
or-. «oe._L-3@8 d i Au_ [o3_MAM ¡ CH + 73/28
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o I have an ownership interest (for a m inim um of six m onths) in a business established in the City of
M iam i Beach (for a m inim um of six m onths).
Nam e of Business _
Business Address _
o I am a full-tim e em ployee of a business (for a m inim um of six months) and I am based in an offi ce or
other location of the business that is physically located in M iam i Beach (for a minim um of six months).
Nam e 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.
S ign re
au
Printed Nam e
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Date
NO TARY
Sw orn to (or affirm ed) and subscribed before m e, by m eans of o physical presence or o online notarization,
s/ D ee.es ? LA4EA 0ET1É
x< Produced ID
City of Miami eqch Board /com m i ttee Member)
Lues ose
Form of Identification
Nam e of Notary , Typed, Printed, or Stam ped
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Received December 17, 2021
Office of the City Clerk