Amanda KnappEmail: BC@miamibeachfl.gov
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):
□I am a resident of the City of Miami Beach for six months or longer.
Home Address_________________________________________________________
□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_______________________________________________________
□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
are true.
Signature Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of □ physical presence or □ online notarization,
this day of , 20 by
(City of Miami Beach Board/Committee Member).
___ Produced ID
Form of Identification
___ Personally Known
(NOTARY SEAL)
Signature of Notary Public
Name of Notary, Typed, Printed, or Stamped
X
23 January 22 Amanda Knapp
X FL. Driver's License
Charles J. D'Agositn
Received January 24, 2022
Office of the City Clerk