Laurence Moser Sep 2022MIAMI BEACH
City of Miami Beach .
l 700 convention Center Dnve
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl .gov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
1 am inc pliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (ch k all that apply):
I am a esident of the City of Miami Beach for six months or longer.
H e Address lt] {p J A:LTIJ{) /}')/ AA I Bet.t111) f[ 33 f 1/D
I have an ownership interest (for a minimum of six months) in a business established in the
Ctty of Miami Beach (for a minimum of six monD s)._ . n
Name of Business: G,ci ~v -Y) l I /)'1 I t'?-/7;
BusinessAddress \11~7/4ck {k,. J) /vi!M( tlah
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0 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 companr. or other entJty or business association.
Under Pe.nalties of perjury, I declare that I have read the foregoing document and that the facts
stat 1taretrue. __
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Received July 19, 2022
Office of the City Clerk