Ray Breslin Sep 2022AOL
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
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
RECEIVED
JUL 22 ?022
C11-Y;F iN41AM1 BEACH
OFFS, r+N rLERK
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.
Home0.— (�-� �!➢ �'" uye1 .. �33,
I b
Address: J
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
Business: BA1 t to y �"l� & 1� C1 MOW V L f
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
Business:
Business
Address:
of
"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.
i;
Signature
Date 7/ 1 1 1