Galen TreuerMI A MI
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeacilfl.gov
Telephone: 305 .673 7411
Received February 18, 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):
s I am a resident of the City of Miami Beach for six months or longer.
Home Address 1150 Euclid Ave #301 Miami Beach, FL 33139
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 penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are""glu a.oc. 21%7%?
Signature Date
Galen Treuer
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of Xphysical presence or o online notarization,
18th February 20 22 b Galen Treuer [h1,(e\y ] U}
(([[ of Miami Beach Board/Committee Member).
FL. Driver's License X Produced ID
Form of Identification
Personally Known
Ciao '(get
Signature of Notary_Public
Charles J. D'Agostin
gèfß., CHARLES J. DAGOSTN i~i"'if-.,_ MY COMMISSION# HH 165705
$! ·3 zj, ¿si EXPIRES: Docomber 14, 2025
%;jjj?" Bonded Thu Notary Puble Underwriters
(NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped