Kathleen Drohan Sep 2022MIAM|IBEACH
City 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
| am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (V) all that apply):
N 0 | am a resident of the City of Miami Beach for six months or longer.
Home Address: \ 44 H Wee Winn kino Ht HO \
L] | 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:
| am a full-time employee of a business (for a minimum of six months) and | 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: “~ Cw? Wor \k ios SARS
Business Address: £5 (OC) VA Sveeel
“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, | declare that | have read the foregoing document and that the facts
stated in it are true.
FR, > o\ a\30
Signature Date
KarWwye en “hala
Printed Name
Received October 5, 2022
Office of the City Clerk