Angel TrianaMIAMI BE ACH RECE IVED RECEIVED
City of Miami Beach
17 00 C o nventio n C enter Drive
M ia m i Beach, Florida 33 13 9
O FFIC E O F TH E C ITY CL ERK
Email: BC@miamibeachfl.gov
Telephone: 305 .6 7 3.74 11
FEB 10 2022 FEB 10777
CITY O F MI AMI BEA CH
O FFICE OE TE IT CLE#k
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):
y' I am a resident of the City of Miami Beach for six months or longer.
or- A«ars ]7 R O Y'/t u4 4 2A i.
□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).
Name of Business _
Business Address _
□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.
e that I have read the foregoing document an tated in it
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Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by mean
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-------~- ity of Miami Beach Board/Committee Member).
rosa hl, ", I- si.e. owwc.ere
Form of Identification ti? i¿ MY COMMISSION # GG 203345
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PeltLCr~II ~K-nown j-. '.~'i EXPIRES:April 30, 2022 %,] ° Bonded Th u Not 'Publle Und erwrters
(NOTARY SEAL)
signature of Notapy Publie_ qrTNn l.¡Vy>
hysical presence or online notarization,
Nare of Notary, Typed, Printed, or Stamped