Joy Malakoff@ MIAMIBEA
OFFICE OF THE
&CITY CLERK
‘Tetephone:305.673.7411
OF AFFIL WITH THE CITY OF MIAMI BEACH
with the affiliation requirement of Miami Beach City Code Sections 2-22Jamincompliance88(check(/)ail that epply):
Tam a resident of the City of Miami Beach for six monthe or longer.
6415 Prhe (ree Drive
0
t
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).
ofName
Business:
Business
ress:
oO
1
am a full-time employee of a business (for a minimum of six months)and
|
am
based in an office or other location of the business that is physically located in Miami Beach
(for a minimum of six months).
ofName
Business:
Business
Address:
“Ownership Interest”means the ownership of ten percent or more (including the
ownership of 10%or more of the outstanding capital stock)in a business.
means any sole proprietorship,sponsorship,corporation,limited liability
company,or other entity or business association.
Under penalties of perjury,
|
declare that
|
have read the foregoing document and that the facts
stated in it are true.
signature Va lube Date Ve OLZ
printed Name «1.295 V,Mela Kote
Received January 5, 2022
Office of the City Clerk