Esteban Porcelli Sep 2022I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (J) all that apply):
I am a resident of the City of Miami Beach for six months or longer.
3411 Indian Creek Dr. Apt 903
Home
Address Miami Beach, FL 33140
❑ I have an ownership interest (for a minimu of six months) in a business established
in the City of Miami Beach (for a minimum ix monthsL%
Name of
Business:
Business
Address:
❑ I am a full-time employee of a busin (for a minimum of six months) and I am
based in an office or other location of the siness that is ph scally located in Miami Beach
(fora minimum of six months).
Name of
Business:
Business
Address:
"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 tree.
Signature s%l Date
l /
Printed Name L s J I 0(4[ E L1—j