Grace CalvaniM l
City of Miami Beach
1700 Convention Center Divo
Miami Boach, Florido 33139
OFFICE OF THE CIIY CLERK
Email BC@m ntamboachi ao
Tolophono. 305 673.7411
Received February 3, 2022
Office of the City Clerk
AFFIDA VIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLOR IDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miam i Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
@ am a resident of the City of Miami Beach for six months or longer.
oso... {331 Che da hc, tua« leol a=tfo
a Ihave an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach ((or a minimum of six months)
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lam 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" moans tho ownership of ton porcent (10%) or more (including tho ownership of
10% or moro of the outstanding capital stock) in a business.
Business" moans any solo propriotorship, sponsorship, corporation, limitod liability company, or other
ontity or businoss association.
Under pt " rethat l have read the foregoing documer mnd that the facts stated in it
are true( Lu [ )2.) 00
oho«oooozaa Signatur Date I e@e
hitea ame
NOTARY
Sworn to (or affirmed) and subscribed before mo, by means of physical presence orX online notarization, ."?h.« January .as22s,_Gaea@av
(City of Miami Beach Board/Committee Member).
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for of ideriification [? pd ",Z MY COMMISSION # HH 165705
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Signature of Notary Public
Ch ar les J D'Agostin
X Produced ID
Nam e of Notary, Typed, Printed, or Stamped