Gladys Navarro 12/31/231
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MIAMI BEACH Received February 10, 2022
Office of the City Clerk
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@rniamíbeachfl.gov
Telephone: 305.673.7411
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):
✓l am a resident of the City of Mì~i. Beach for six months or longer.
or.won» Io o llla, host N,± i
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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"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. p'.~ªJ.tie. ; .... of ~rJ~.'z'• I d. eclar.e tha .. t·l.have read the foregoing documvent and that t · facts stated in it
are tvyé, Jr -2, /2 y lat< Ce.dz» c> 'DO o?=A 'SÌ; .. ª .. tu:\ /í Date tall4s NA oAa)
Printe ià
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ru physical presence or rnline notarization,
. 10th February 22 Gladys Navarro
[h[s da/ Of ,l)_y -
________ (City of Miami Beach Board/Committee Member).
FL. Driver's License X Produced ID
Form of Identification
Personally Known
Cao. U'get
3##Ee., CHARLES J. DAGOSTIN ¿$"„j"; wcounwssow t«sos
%3,9dis? ExPREs: Decamber 14, 2025 "·g" onded Tru Notary Public hndorwritors i»i
(NOTARY SEAL)
Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
XReceivedFebruary102022OfficeoftheCityClerk