Honey BernsteinC ity o f M ia mi B e a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
Received Febru ary 8, 2022
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
(/) all that apply):
~- a resident of the City of Miami Beach for six months or longer.
Home Address I2 co Wet £re AA_
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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"O w ne rs hip Intere st" m e ans th e ow n ership o f ten p ercen t (10 %) o r m ore (in clud ing the ow nership of
10 % or m ore of th e outstan d in g ca p ita l stock) in a b usine ss.
"B usine ss" m e an s any sol e p rop rie torsh ip, spo nso rship, corp oration , limi te d liability com p any, or oth er
entity or busin ess a sso cia tio n. '
Under penalties, of perjury, I declare that I have read the foregoing documen t and that the facts stated in it là. k±.o ,,> -hl¥ ,ad
Signature l} Date
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Printed Name \
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or online notarization,
. 8th Feb ru ary , 20_22 by H o n ey B ern stein
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(City of Miami Beach Board/Committee Membeh pee
FL . D riv er's Li cen se .s.. CHARLES J. DAGOSTN
f $ 3 w&Emis@ius :»: «: (4.2025 j, „ii EXPIRES: Decem ber 14, "5íé" Bonded Tru Notary Pubic Underwrers
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Produced ID
Form of Identification
Personally Known
Ciao DO'get (NOT ARY SEAL)
Signature gf_Nota%9plié,, Charles J. D' gostin
Name of Notary, Typed, Printed, or Stamped