Christopher Gloede Sep 2022MIAMI BEACH RECEIVED
City of Miami Beach JUL 22 2022
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK OFFICE OF THE CITY CLERK
Email: BC@miamI-b-eachfl.gpv
Telephone: 305.673.7411
AFFIDAVIT
1
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—_ 11� D CYSOr• Ave,, ACZ/11. ezccL1, fl— 33139
n 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
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 (100%) 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 f�erj ry, declare that I have read the foregoing docume t and that the facts stated in it
are true
Signature Date '—
ris lir Gbele-
Printed Name
NOTARY
Sworn to (or affirme/d) and
subscribed before me, ears of , hysica presence or n nline notarization,
tf9ey of v"" 20� by C�
(City of Mho^I'vee-5
i Beach Board/Com ttee`Me�mb�e►r))..
t Produced ID �G W/,,
Form of Identification
so ly Known
(NOTARY SEAL)
Sig . lu f Nc Public
:►.'ice, CHARLES J. DAGOS71N
Name of No ry, Typed, Printed, or Stamped.�;A".g.,
.'s MY COMMISSION# HH 165705
EXPIRES: December 14, 2025
sot c�?.•' Bonded Thru Notoy Public undemriters