Jack Benveniste 12/31/2312/31/26
1/25/2022 N/A
1/25/2022
Received January 25, 2022
Office of the City Clerk
1/25/2022
1/25/2022
1/26/2022
25th Jan
Ml IBE
City of Miami each
700 Convention Center rivo
Miami Boch, Florida 331
OFFICE OF THE CITY CLERK
Email. BC@ILA Achf.gov
Telephone; 305 673.741
RECEIVED
JAN 26 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WIIH IHE CITY OE MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADOE
I am in compliance wth the affillaton requirement of Miami Beach City Code Sections 2-22 (4), (check
(/) all that apply)
is lam a resident of the City of Mari Beach for six months or longer
have an ownership interest {for a minimum of six months} in a business established in the City of
Miami (far a minimumn of stx months)
Name o! Business ZUM DE.er
usmess Address. IA_yy-0_ y] yd,ry2pi
--- ¡;:.
t am a full-time employee of a business (far a minimum of six months) and 1 am based in an office or
other location of the business that is physical ly located in Mi ami Beach (for a minimum of six months)
Ownerstup interest means the ownership of ten percent (10%) o more (including the ownership
10% or more ot the outstanding capital stock) in a business
"Business means any sole propnetorship, sponsorship, corporation, limited tiattty company, or other
entity or business association
NOTARY
Swarn to for affirmed) and subscribed betore me, by means of physigal presence or z online notarization,
·25 .0/8 40%» O leudaste
22 /,212,22.o.e4gp@ E#fifEE.
,- l r..... - lZj;, cs$¿ EXPIRES: December 14, 2025
Farm of identification "j$° Bonded Tru Notary Public Undenwrhers
nwn laicaasassrsisaswad
(NOTARY SEAL)
X
Received January 25, 2022
Office of the City Clerk