Joshua RobinsM IA M I 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 .7 411
RECEIVED
MAR 31 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):
o I am a resident of the City of Miami Beach for six months or longer.
Home Address 1800 W 24 St, M iam i Beach, FL 33140
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 _
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).
Name or ousmess Scott Robins Companies, lnc.
sues A«ares 230 5th St. Miami Beach, F133139
"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
«os Me 33002022
Signature 71- Date
Joshua Robins
Printed Name
NOTARY
Sworn to (or affirmed) an~ subscribed before me, by mean7 of~ysical p
6
sen¡e
1
o'r. □;n~ne notarization,
o.a a lt 22_)OSha1 ,v2>
~ity of ~mi B:ach Board/2:~ittee Member).
X roaoceo o /_A ire s 1 se
Form of Identification
gêij, CHARLES J. DAGOSTIN $'? r coM ss oN H is7os
%gk&as ExPREes: Docomber 14, 2025 f;ii? Bonded Thu Notary Public Undenwriters
(NOTARY SEAL)