Glendon Halle"° ,nota + A%}
..»%À#M/BEACH
W'o F" City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@m iamibeachfL.gov
Telephone: 305.673.7 411
Florida
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):
1am a resident of the City of Miami Bqach for six months 9/on9er.
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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).
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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).
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"Ownership Interest" means the ownership of len 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 liabílily 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 " 1$2 /ese
Signature Dale I
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of u physical presence or$online notarization,
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(~~_of!~ Beach BoardlCommjlle~ Member).
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..si. CHARLE S J. DAGOSTIN éêj$ "ê wcowssor toso %j,Jk .i} xts:. Deon»»r 14,2025 };á° Bonded Tu Notary Public Underwriters
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