Michael DeFilippiMIAMI BE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JAN 12 2022
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov CITY OF MIAMI BEACH
Telephone: 305.673.7411 OFFICE 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 260 Euclid Ave #28 Miami Beach, FL 33139
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).
Name of Business ------------------------
Business Address _
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).
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 stated in it
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Signature Date
Michael DeFilippi
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means oM"ysical ~"sene~ ... º onli~e notarizaijon, sa.40«64 a0, M1kae/ pet lpf21
(City of Miami,each Board/committee Member).
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Form of Identification
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