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Jonathan Freidin 12/31/23City Commission 12/31/23 12/31/27 1/21/2022 1/5/2022 1/21/2022 1/21/2022 1/26/2022 Received January 21, 2022 Office of the City Clerk 21 Jan MI AMI BEACH 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 41 I R eceived January 21, 2022 O ff ice of the C ity C lerk 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 Aaoress _IL ]std ko ±1707 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). []3mp9 (f Py]PSS P1[SI[e ,, (][feSS 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). [Qr% (f [J S][S - P]1ms,S ([r%Si- "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 pen are true. Signature I declare that I have read the foregoing document and that the facts stated in it I]4/o2z Date I Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means ofX physical presence or o online notarization, a.2 1 aay or Jan u ar y 2022o by "onathan Freidin _________ (City of Miami Beach Board/Committee Member). FL D river's Li cense X Produced ID Form of Identification Personally Known Cao, D'A, ·ut sio@ore o @ o ey a. ' •• CHARLES J. DAGOSTIN f~:&·•'~\ MY COMMISSION# HH 165705 h;; ;li EXP IRE S: Decambr 14, 20 25 ·'A. y6 72a±¿$? ponded Thu Notary Public Underwriters ·£ts° (NOT ARY SEAL) Charles J D'Agostin Name of Notary, Typed, Printed, or Stamped X Re ceived January 21, 2022Office of the City Clerk