Liliam Lopez Sep 2022Email: BC@miamibeachfl.gov
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):
x□ I am a resident of the City of Miami Beach for six months or longer.
Home Address:__4200 Alton Rd. Miami Beach FL. 33140_____
□ 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:___ __
□x 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. South Florida Hispanic Chamber of Commerce non profit
Business Address:_____ 333 W 41 Street Suite 300 Miami Beach FL.
33140_______________
“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.
10/122 signature Date
Liliam M Lopez
Printed Name