Jack FinglassMIAM I B EA C H
City of Miomi Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: 3C @miam ib each fl.gov
Telephone: 305.673.7 411
/eJolet
RECEIVED
DEC 22 2021
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
, +id« nt tth C i fMi ·B ht is the Jack L. Finglass L) am a resident of e 'ity of liami 3eact for six months or log?ß9¡ North B ay Road
M iam i B each, FL 33140-2038
Home Address: --------------------------
D 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:_ LL[y ------,174,v._,7....,,~'1-----------------
Business Address: ------------------------- □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:. _n]/[_ -------1¡-'d•'+,__.__ _
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 ·
st
erjury, I declare that I have read the foregoing document and that the facts
Date
pr