Davron BanksM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email. BC@miamibeachfl gov
Telephone: 305.673.7411
RECEIVED
JAN 26 2027
C IT Y O F M IA M I B E A C H
OFFICE OF THE CITY CLERK
A F F ID A V IT O F A F F ILI A T IO N W IT H T H E C IT Y O F M IA M I B E A C H
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).
o I am a resident of the City of Miami Beach for six months or longer.
pt)mm J [[[j
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).
[amne f [JS/m@Si
PS[Jg[mes,s, ]feSi
-y/ 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).
Business Address
N am e of B u sin ess_~"-'--;__,_\_,..\ (V"\'--'--'_,,.o ..... i-'-"'-e--M"-'-''--'Ç"""'t,-(Y)"'--..:..·.,_, _Î)-\:,,<'-"e...,o..~c"'-< Y'\:......;. _
Loo Losh 9to o Dye, M aor i . (a ch 3 1 3
"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 E> a 2a Il-yl/&
Sign! Date
Ds roo Te,otea t,,ot $
Printed Name
Sworn to ( or affir
thi/¡;_dayof
NOTARY
ed) and s"bscc ibed ?efo re me], means o~ysical ~•se nee or o online notarization, e.'„2l, )Au ò! [reto [a{s
("" w • Beach Board/Cot ye Member).
/¡da ea,e Produced ID
Form of Identification
(NOTARY SEAL)
Signat