Carl LinderMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
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 (/)
3¥that apply):
I am a resident of the City of Miami Beach for six months or longer. J
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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).
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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 sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
l d9/are that I have read the foregoing document andthat the facts stated in it
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of hysical presence or o online notarization,
City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
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Received December 17, 2021
Office of the City Clerk