Brian Elias Sep 2022AAIAAAIBTACH
Clty of Mloml Beqch
1700 Convention Center Drive
Miqmi Beqch, Florido 33i39
OFFICE OF THE CITY CLERK
Email: EC@rnialnLbeachfl .qov
Telephone: 305.67 3.7 41 I
AFFIDAVIT OF AFFILIATION H 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):
X I am a resident of the City of Miami Beach for six months or longer.
Home eaaress:/y'/f l0vs€f l,lRaoup Drive, 4?t, /a6Hitpt 8arci,7/ tti;q
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
n I am a full-time employee of a business (for a minimum of six months) and I am based in an
otfice 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 lnterest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) rn a busrness.
?usiness" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or busrness association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true
a, /".Zaa.2
Signature
Br<tt^t D. € / ,',e "Printed Name
Date
Received July 19, 2022
Office of the City Clerk