Scott DiffenderferM IA M IB H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
FEB - 9 2022
CIT OF MIAM I BEACH
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
( ā) all that apply):
āI am a resident of the City of Miami Beach for six months or longer.
Home Address 9 Island Ave. #1501, Mlami 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 ------------------------
H1[S[PSS \([]resS
āI 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 Compass Florida LLO
605 Lincoln Road, 7th Floor, Miami Beach, FL 33139 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.
Sig
t I have read the foregoing document and that the facts stated in it
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Date 7
Printed Name
NOTARY
Produced ID
sworn to (or affirmed) and subscribed before me, by means of physi
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Signature
.ii¿¿.. CHARLES J, DAGOSTN $" j$ "f wcouwusso w 1osos
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Name of Notary, Typed, Printed, or Stamped