Paul ThomasMIAMI 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
APR -4 2022
CITY OF MIAMI BEA CH
OFFICE Or THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST ATE 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):
VI am a resident of the City of Miami Beach f r six months or longer.
Home dare, o \l>ck 202
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 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 an
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Signature
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Date
that the facts stated in it
NOTARY
Sworn to (or affirmed) an~ subscribed before me, by means o~ysic~~esence or o on~ine notarization,
s/..a p.] »22» Paal'A. Tho s
--------- (City of iami Beach Board/Committee Member). eeeeeeeeeeeeeenee
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Form of Identification hÉj,gkç$$ ExREs: pecamber 14, 2025 f;jg Bond6d Thu Notar y Public Underwriters
Produced ID
(NOTARY SEAL)
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