Robyn Malek Sep 2022City of Miami Beach
1700 Convention Center Drive
Miami Beach, Ftofida 33139
OFFICE OF THE CITY CLERK
Email: BC0miamibeachfl.aov
Telephone: 305,673.7411
RECEIVED
AUG 12022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in c pliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (c J.') all that apply):
I am a resident of the City of Miami Beach for six months or longer.
Home 17 U SU,,n �4
Address:
❑ 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
"Ownership Interest" means the ownership of ten percent (10516) 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.
3-3)31�
Signature
Printed Name
Date
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