Laurence HerrupMIAM/BE ACH
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
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):
o I am a resident of the City of Miami Beach for six months or longer.
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□x 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 Laurence A Herrup CPA PA
Business Address 300 71 st Street Ste 620
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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
~ aretrue. ~ 12/21/2021
Signature Date
Laurence A Herrup
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of~hysical presence or o online notarization,
mns 2l_ aay o Dgaber 20 y Lurte A rryg
--------- (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification 4 Notary Public State of Florida
t@ Stephanie Horton g My Commission
IIIIILR HH 183926
I
Nam e Gr NEE,i y, Typ ed, Printed, or Stamped