Sarah LeddickMIAM I BEACH
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
RECEIVE D
EC 22 2021
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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 Section s 2-22 (4), as (check
(/) all that apply):
l am a resident of the City of Miami Beach for six months or longer.
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I have an own ership interest (for a minim um of six months) in a business establish ed in the City of ?$y o
Miami Beach (for a minimum of six months).
Name of Business _
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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).
Name of Business _
PI1S[[eSS [(](]f9Sì-
"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
are true, „2y2 > _/_/ s < t{ut (a,20,dt
Signature Date
Sa r i LL_ Le«Ok<
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ical presence or o online notarization,
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(~ of Miami Beach BozC_?mmittee Member).
Proave«o ED)oer «eo ve
Form of Identification
ally Known
(NOT ARY SEAL)