Andres AsionDocuSign Envelope ID: 5021B4F9-EC4D-478D-8A4D-AB 8B2 2134517
M IAMI BEACH
City of Miami Beach
1700 C o nv e n tio n C e nte r D riv e
M ia m i B e a c h , Flo rid a 33139
O FFIC E O F TH E C IT Y C LE R K
Email: BC@miamibeachfl.gov
Te le p h o ne : 305.673 .7 411
RECEIVED
MAR -9 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
[] 1am a resident of the City of Miami Beach for six months or longer.
1000 s Pointe Drive, Apt 2204, Miami Beach, FL 33139 Home Address: _
D 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: _
D 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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stc~i.:'I' true. 3/9/2022
Sign¿Km7me pr
Andres Asion
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