Marjorie YorkMIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
MAR 15 2022
CITY OF MIAMI BEA CH
OFFICE O THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
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):
f am a resident of the City of Miami Beach for six months or longer. , _ ..O • Jj ;ff/
rs. s2 7ls" $t 4 hag et,s «
D I have an ownership interest (for a minimum of six months) in a business established in t;l? / ?f
City of Miami Beach (for a minimum of six months).
Name of Business: _
H[JS]fess J\((foSS,
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).
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3yS[/es (][r@SS,
"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 il are true. • *¥ Z,
Date'