Joelle GringartenMIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
RECEIVED
MAY 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):
../ I am a resident of the City of Miami Beach for six months or longer.
Home Address 4585 Adams Avenue, Miami Beach, Florida, 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).
[ar f [ys[n@SS
3Is[fess J(]fosS
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).
[[are f Hygin@sS
[3[ys[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 document and that the facts stated in it
are true. LI , lo»l May 27, 2022
Signature Date
Joelle Gringarten
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ysical presence or o online notarization,
«27,a0/01 a Joellc Gov9et!
(City of Mi i Beach Board/Committee Member).
X< ecu o [t loo_L eo se
Form of Identification
e
gi i;g., CHARLES J. DAGOSTN
£ b ,¿ MY coMMusIoN # HH 1s7os %j,9dis; ExPREs: Decomber 14, 2025 @?" Bondod Thu Notary Public Underwriters
Sign t f N
Name of Notary, Typed, Printed, or Stamped