Cameron McLainDocuS ign Envelope ID: 1BC53A72-A49C-4439-9560-4B7D30064288
MIAMIBEA
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
HECEIVED
FEB -72022
cr OF MIAMI BEA!},
OFFICE OF THE CITY CLER
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.
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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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[3JS[fess (hr@SS
"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. ~~ __ 2_f6_f_2_0_22 _
Signature Date
Cameron Mclain
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, means of physical presence of online notarization,
de/,«/ka.a2» ro, K(A
_________ (City of Miami Beach Board/Committee Member).
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Form of Identification
P 'soyally Know
Signa
ry, Typed, Printed, or Stamped