Josephine ManningMIAM I BEACH
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
RECEIVED
FEB -7 2022
CITY OF MIAMI BEACH
OFFICE OF 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
(0 aif @hat apply):
V I am a resident of the City of Miami Beach for six months or longer. o-.se. I+ò Qg._Di--,B 3313%
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 ~onths).
Name of Business ()
Business Address _
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).
Name of Business _ -
Business Address _
"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
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ignatul Date
íose,le • 4v""r3
Printed Nan
NOTARY /
Sworn to (or affirmed) and subscribed before me, by means of 4physical presence or u online notarization,
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(City of Miami Beach Board/Committee Mem'' oaeeeeeeesemen meetemeg'
Giii, RAFAEL E. GRANADO $$ "f; wcowwssow won
%jh,9Nk,is; ExPREs: September 16, 2025
f;jg" ponded Thru Notary Public Underwriters
Produced ID
Form of Identification
Personally Known
Signature of Nu (NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped