Ava Annunziato Sep 2022M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.qav
Telephone: 305.673.7411
RECEIVED
AUG 1 8 2022
CITY O F M IAM I BEA CH
O F FIC E O F TH E C ITY C LE R K
A FFID A V IT O F A FFILI A T IO N W IT H TH E C IT Y O F M IA M I B E A C H
S T A T E O F FL O R ID A
C O U N T Y O F M IA M I-D A D E
I am in co m p lia n ce w ith the affi lia tio n req uirem ent of M iam i Beach C ity C ode Section s 2-22 (4), as (check
( ✓) all th a t app l y):
'r:f. I am a re sid e nt of the C ity of M ia m i Beach fo r six m onths or longer.
H om e A ddr e ss 4%4o Al#n Poad M ani leach, F 33140
1 Ih a ve an own er sh ip in te rest (for a m inim um of si x m on th s) in a busin ess established in th e C ity of
M ia m i B each (fo r a m inim u m of six m onths).
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o I am a full-tim e em p lo ye e of a business (fo r a m inim um of six m onths) and I am based in an office or
oth e r lo cation of the busin e ss that is physically located in M iam i Beach (fo r a m inim um of six m onth s).
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"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.
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lare that I have read the foregoing docum ent and that the facts stated in it
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P rin te d N am e
N O T A R Y
S w o rn to (o r affi rm ed) and sub scribe d befo re m e hysical presence or o online notarization,
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(C ity.o f M iapg i Beach Board /C om mi tte e M em b er ).
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peeee se. eemette giij, CHARLES 4. AGOSTAN
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33}, ;g EXPIRES: December 14, 2025
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(N O TA R Y SEA L)