Natanya Rogoff Sep 2022MI A MN/BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, floricda 33139
OFFICE OF THE CITY CLERK
Email BC@mamuteachfl gov
Telephone 305 673 7411
RECEIVED
SEP 01 2022
CITY OF MIAMI BEACH
OFFICE OE THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH_ THE CIT Y OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply)
lam a resident of the City of Mi am i Beach for six months or longer
or e Aocar e s».'5 2 2 3 1, &a Rd ti. 'uh, EL 2 51 0
o Ihave an ownership interest (for a mi nimum of six months) in a business established in the City of
Miami Beach (for a minimum of six months)
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o lam 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 th at is physically located in Miami Beach (for a minimum of six months)
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"Ownership Interest" means the ownership of ten percent (10%) or more (including tho ownership of
10% or more of the outstanding capital stock) in a business.
Business" means any solo proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association
Under pen,fltles of perjuryr~I declare th_,at I have read the foregoing document and that the facts stated In It
are true.,'.l,, lf2
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by mean~ o~ysical presence or o online notarization,
»82, ·Au«ash623,Na1ipa ojo£°
(City of Miam» 3each Board/Committee Member)
7 vp'vues Le»se
Form of Identification
Produced ID
.g3èiji, CHARLES J. DAGOSTN
$" ? M Y coussoN H 1os7 os j,ah&.is ExPREs: pecamber 14, 2025
$êÉé%" Bon ded Thr u Notary Pub lic Un derwrit ers
(NOTARY SEAL)