Sabrina CohenMIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
RECEIVED
MAR 14 022
CITY OF MIAMI BEA CH
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):
] lam a resident of the City of 'iami Beach for six months or longer.
Home Awaress_"44 iv tu "p'
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).
[Jar9 [ [[s[mess
[JS[fess J(]}feSS
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).
[[9[o ( PIS][es
H3us[fess [dresS
"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 docume
ao e, „/.Ito22
.L.,l
the facts stated in it
Si
2±h Pfinted 7
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by~means o~sical prese_nce or o online notarization,
wL»0%%(r _2s,. Solfa ohe-
_________ (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
T'· CIMRlESJ. OAGOSTIN ? ? MY coMIssIoN # HH 165705
±j, ¿ EXPIRES: December 14, 2025
jjjç" Bonded Tru Notary Public Underwriters
(NOTARY SEAL)