Lauren Foster• i /]
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City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamnibeachfl.gov
Telephone: 305.673.7411
PECEIVED
IAN 18 702
OIT OF MIAMI BEACH
OFFICE OF THE CITY CLER'K
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):
X I am a resident of the City of Miami Beach for six months or longer.
roro Asare o owT A//a na .37 .
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 f-J_~/,_,_A--'------------------
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).
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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.
Under penalties of perjury, I declare that I have read the foregoing document
""8 91, ,2023
Signature Date
l_. FoSTx
Printed Name
NO TARY
Sworn to (or affirmed) and subscribed before me, by means o~hysical presence or o online notarization,
this J3 day i 54 .2022by @ F-)
________ (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
_] Pers, 1ay Known
ii;;. EST DONALD KELLY ($pí6\ otory Pubi« -· state o+ Flondda t{¿ $l' j sj com mission # HH 055992 %%2%$;s$ y conn. éres or 2, 2034
"sanded through National Notary 5"
Signature Notary_Public -+»
Name of Notary, Typed, Printed, or Sta