Gabriella KalmanowiczMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beoch, Florida 33139
OFFICE OF THE CITY CLERK
Emai l: BC@miamb eachfl gov
Telephone: 305.673.7411
RECEIVED
APR 14 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):
1am a resident of the City of Miami Beach for six months or longer.
H om e Address. 30 »dli l_. Hie Sea[_ 33lg j
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).
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□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. _
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"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
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Signature Date ab»clle Alquov
Printed Name
NOTARY
Swom to (or affirmed) and subscribed before me, by means of physical presence or o,online notarization,
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iy of Mi~ Beach Board/Committee z:be r).
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Form of Identification
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;GR2.. CHARLES J. DAGOSTIN $""%., ' { "¿ wvcouussoN # H t os7os ¿!sé ExPREs: Docember 14,2025
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