Spencer HenningsM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beoch, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachflqoy
Telephone: 305.673.7411
HECEIVED
JAN 12 2022
OIT OF MIAMI BEACH
FFCE OF THE CITY CLERK
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
(/) all that apply):
V I am a resident of the City of Miami Beach for six months or longer.
Home Address_SOS5 otia Due .LA. [ia, baa £.33tao
o 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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P1y,]me,S, (]feSS
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).
[[an t[ yS[m@SS
P1y,[mes,s, (]fes-
"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 tue. p/
Sg.: ',La= Ol_/e/A )
Sigrure t Date'
92ga.,, f. H,a,,a4
ed Name J
NOTARY
Swo¡n to (or affirmed) and subscribed before me, by means of o physical presence or'X6~Une not~rization,
.es..Jod4.2, Speere Hd5s
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' Ju"S l'ceo Se
, Form of identification
Sign
RY SCHARLES J. DAGOSTIN
MY COMMISSION # HH 165705
" ÈXPIRES: Decombor 14, 2025
%jj(kl Bonded 'Thu Notary Publ ic Undenwtors