Lisa ColeMI AM I BE A CH
City of Miami Beach
1 70 0 C o nvention Ce nter Drive
Mi am i Beach, Florida 33 13 9
OFFICE OF THE CITY CLERK
Emai l: BC@mniamboach.gov
Tel eph on e: 30 5 .6 7 3 .7 4 11
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA
REC EIVED
FEB -8 7022
CI TY OF MIAMI BEA CH
FF ICE O F TH E CITY CLERK
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-
( ✓) all that apply):
)( I am a resident of the City of Miami Bea ch for six months or longer.
Home Adres B660o A(soy
o I have an ownership interest (for a minimum of six months} in a business establish
Miami Beach (for a minimum of six months).
[arpa[ by1 peso
p3us[me ss ddfeSS l
M I am a full-lime employee of a business (for a minimum of six months) and I am ba in an office or
other location of the business that is physically located in Miami Beach (for a minim u of six months).
fare f bys]fess_Lilt ll
"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" moans any sole proprie torship, sponsorship, corporation, limited liability
entity or businesy association.
ny, or other
riry, I declare that I have read the foregoing document and that the acts stated in it
are
Signature •
l(ol e>
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or onll notarization,
es( a a q February ,2o 22_y Lusa Cole '
(City of Miami Beach Board/Committee Member).
FL Driver's License X Produced ID
Form of Identification
, Personally Known
Ciaea D?'geti
Signature of Notary Public
Charles J. D'Agostin
(NOTA SEAL)
ç3ji;ç., CHARLE s a. AGosT $j"; wcouussron tsros %3pt3ks$ xPn Res: Deem 14,202s í;;i?"" Bonded Thru Notary Public Underwriters