Randi FreedmanM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
RECEIVED
MM4R 15 2022
CITY OF MIAMI BEACH
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):
□I am a resident of the City of Miami Beach for six months or longer.
Home Address _
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).
Name of Business _
Business Address. _
ò< 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 Logistics Management Group
Business Address 1900 Purdy Ave, #715 , Miami Beach, FL 33139 second 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 so/e 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 true.
Rad, Feedwav 3-15-22
Signature Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ~sical presence or□online notarization,
./S sh@It Rwl Fecl
X Produce ID
(City of Mai Beach Board/Commjttee Member).
/ biuers l=go $c
Name of Notary, Typed, Printed, or Stamped
."s.. CHARLES J. DAGOSTIN $" j è% wcow«ssio»r 1sos
#,Jg.is$ ExPREs: Dem ber 14, 2025
j7s$ Bonded Thu Notary Public Underwrit ers
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