John LeeMIA\tB
City of Miami Beach
1700 Convention Center Drive
M iami 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 Sections 2-22 (4), as (check
() a/fat apply):
/ I am a resident of e City of Miami Beach for six months or longer.
tore A«aress I Itou- 'tit" V'si
□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).
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□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 -------------------------
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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.
t I have read the foregoing document and that the f cts stated in it
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Date s
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of #physical presence or online notarization,
. 22nd, December John Lee this _-aay of , 20~by _
_________ (City of Miami Beach Board/Committee Member).
FL. Driver's License X Produced ID
Form of Identification
Personally Known
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Signature of Notary Pullf
C h a rle s J. D 'A g o stin
9 e s , CHARLE S J. DAGOS TIN ff@,7 wgm±EE#ks
#j¿, ¿$S EXPIRES: December 14, 2025
"·;;{$% Bonded Tu Notary Public Underwriters i»
(NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped