Julian LinaresMIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
RECEIVED
JAN 19 2022
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
ST ATE 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):
,/ I am a resident of the City of Miami Beach for six months or longer.
Home Aadress_6 6Oo oe'A> I I''' urn red 33({0
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.
that I have read the foregoing document and that the facts stated in it L [p. /4.2022
Signa baie
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means ot)(P'hysical .. presence or o online notarization,
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CHARLES J. DAG. '
MY COMMISSION Hi.
EXPIRES: December i4,...
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(City of Miami \l('•ch Board/Committez mber). h truc e
Form of Identification
Name of Notary, Typed, Printed, or Stamped