Alex Carrasco/E,A //] l/ru\
City of M ia m i Bea ch
17 0 0 Con v enlion Center Drive
M ia m i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emai: BC@miamibeachß.goy
Telephone: 305.6 7 3.7 411
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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o I have an ownership interest (for a mínimum of six months) in a business established in the City of
Miami Beach (for a mínimum of six months).
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V I am a full-time employee of a busí~ess (for a mínimum 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.
jury, I declare that I have read the foregoing document and that the facts stated in it
/e4 23 -o>t
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or Xonline notarization,
ht6 22 day or December _,2o21y eXander Carrasco
(City of Miami Beach Board/Committee Member).
X Produced ID FL DRIVERS LICENSE
Form of Identification
Personally Known
Ci.i 'per (NOTARY SEAL)
Signature of Notary_ Public
Charles J. u'Agostin
Name of Notary, Typed, Printed, or Stamped .iii, CHARLES J. DAGOSTIN ?j? wcoMwsso + 1os7os
#j,%k.is; ExP RE s: December 14, 2025 @?" Bonded Thru Notary Public Underwrit ers
Received December 22, 2021
Office of the City Clerk