Robyn Malek Sep 2022 (2)RECEIVED
City ol'Miami Beach SEP "" 6 ZU22
1700 Convention Center Drive
Miami Beach, Florida 33139
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK OFFIGF O TIE CITY CLERK
Email: BCD-miamibeachfl.gov
Telephone: 305.673.7411
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),
;(chec (./) all that apply):
I am a resident of the City of Miami Beach for six months or longer.
63
Home ( J 0 1 J Vy1rG� q �W 6"r �� � 3
Address: 1
❑ 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
Business
Business
Of
❑ 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 (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 true.
Signature 6
Printed Name ��\ , ✓� A
Date 5 / 1" /