Karen Edelstein Sep 2022MIAMI BEACH
1700 Convenlion Center Orive
Miami Beach. Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@m1amiheacbO OOY
Telephone: 305.673.7411
City of Miami Beach
AFFIDAVIT OF AFFILIATION WITH 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):
rn1 I am a resident of the City of Miami Beach for six months or longer.
HomeAddress: 3:22. w. yq+n 5:f: . MrAtl/1 Btrttl 22/fv
D I have an ownership interest (for a minimum of six months) in a business established in the
City or Miami Beach (for a minimum of six months).
Name or Business:. ________________________ _
Business Address: ________________________ _
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 theownership of 10% or more of the outstanding capital stock) in a business.
'Business· means any sole proprietorship, sponsorship, corporation, limited liability companr, or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts=ar e t N �! _(4(1 �i&n +-20-:2;:i_
Si• nat re ,Date\-<.ct v"o EA e fs-k In
Printed Name
Received July 20, 2022
Office of the City Clerk