Alberto RaveloE
City of Miami Beach
17 Cowentin Center rise
Miami Besch, Flrdo 33 139
OFFICE OF THE CO IY CLERK
€ma E C@mar:gachf Gou
Tlephone. 305.673.7411
Received February 2, 2022
Office of the City Clerk
AF FID AVIT O F A FFI LI A TIO N WI TH TH E CITY OF MIAMI BEACH
STA4TE OF FLORIA
COUNTY O F MIAMI-OADE
t am in compliance with the afflianon requirement af Miar each City Code Sect ions 2-22 {4) as {cteck
/) all that app'y)
s/ lam a resident of the City of tam Beach far six months or tonger
Hame Address.a?l .Seel'' ts Tit L
I have an ownershup interest (for a minimum of six months} in a business established in the City t
Miami Beach (for a minimum of six months)
n1 }am a fuli-time employ ee of a business (for a minimum of sx montts} and 4 am based in an office or
other location of the business that is physically located in Miami Beach (tor a minimum of six months1
Nare o 3usiness
3/7
'wvnership integst means the awnorsbp cf ten percert (15%) o more (including the ownership ot
10% o r more o f tho outstanding cap ita l stock} in a business
Busiess" m eans any sole proprietorship, sponsorsh ip, corporation, muted liability compan y or other
enfity or bus.íne ss ass· 'atfer)
re that I have read the foregoing doc ument and that the facts stated in t
00eeeoe
Pnnted Name
NOTARY
Sworn to (or affrmed) and subscrited tefo re me by means otX„physical presence or.u online notarzaton,
we „a_aousa4 202z plaids (e to_
City of Mamu Be arh Bard;Com mittee Member)
Produced ID
form cf identification
N am e of Notary Typed Prin ted , or St am p ed