Cynthia EsquivelEmail:
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):
[Jg(__ I am a resident of the City of Miami Beach for six months or longer.
Home Address: \ 0 � / vf 6J rvi 0 1:ii-5)39
D I have an ownership interest (for a inimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
Name of Business: --------------------------
Business Address: _________________________ _
D 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: --------------------------
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 penalties of perjury, I declare that I have read the foregoing document and that the facts
(7'"!-ed in it are tr. ,� .�1/ \M Lu7� \-\--)-A
Signature C µ�i \{c:e, Date
Printetj Name
Received January 7, 2022
Office of the City Clerk