Eddie SierraMI A MI BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
Received February 9, 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):
o I am a resident of the City of Miami Beach for six months or longer.
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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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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 penaltie
are true.
rju,I declare that I have read the foregoing document and that the facts stated in It
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Signature \ dd Sr
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of a physical presence or o online notarization,
h. 7th d f February 22 Eddie Sierra [[ ldy Ol ,))y -
(Ully of Miami Beach Board/Committee Member).
Produced ID
X Form of Identification
Personally Known
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(NOTARY SEAL)
Signature of Notary Public
Name of Notary, Typed, Printed, or Stamped