Ariana Hernandez-Reguant1IA,l
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ai l: B C @m iamibeachfi_gov
Telephon e: 305.673.7411
RECEIVED
FEB 3 2022
CITY OF MIAMI BEACH
OFFICE OE THE CITY CLERK
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):
¡j( I am a resident of the City of Miami Beach for six months or longer.
ome Adaress "1woes"·1+Mama
u 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 mínimum of six months) and I am based in an office or
other location of the business that is physically located in Míamí Beach (for a mínimum of six months).
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"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
are true. /J. tP ~ __ F_e_b_3_, 2_0_2_2 _
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Ariana Hernandez-Reguant
Printed Name
NOTARY
Sworn J (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
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(City of Miami Beach Board/Committee Member).
Produced ID
- Form of Identification
> Persona1y K O}); 1, 7 #a P. fo l út (NOT ARY SEAL) #ge„pe 1)e icho [fe_hQ
Name of Notary, Type d, Printed, or Stamped