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Wende Weber Sep 2022City of Miami Beach 1700 Convention Center Drive Miami Beach,Florida 33139 OFFICE OF THE CITY CLERK Email:BC@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),as (check (✓)all that apply): □I am a resident of the City of Miami Beach for six months or longer. Home 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 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 Date Printed Name 435 21st St #324 Miami Beach FL 33139 Wende "SUNNY" Weber Wende Weber 09/07/2022 Electronically Signed using eSignOnline™ [ Session ID : 5e0e7c39-86ed-49d7-9707-d8588da0b1a7 ]