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Carmen Browne Sep 2022MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC cDmiamibeachfl.gov Telephone: 305.673.7411 RECEIVED JUL 29 2022 CITY O; \MAMl BEACH OFFIrt r `P CITY CLERK 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 (J) all that apply): Lei 1 am a resident of the City of Miami Beach for six months or longer. Home Address: S s /V'nr-�1., � �o TZ'� �� . �kja Mk_ -'JQci.c , P L �3_ car ❑ 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 (109,6) 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 s Sig ure \nDate 710 �-b "I V\,C--, Printed Name