Carmen Datorre Sep 2022MIAMI BEACH
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City of Miami Beach 0 C T 17 2022
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY 01: MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BCO)rniamibeachfl.gov
Telephone: 305.673.741 1
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 (J) all that apply):
I am a resident of the City of Miami Beach for six -months or longer.
Home Address:. b ('l.�tY�C� - . F l j' 1
V
1 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).
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Name of Business: _ ,���''`'-r-X �-" �`�-
Business Address: 5 9'(41
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: `���" �"`�`'' / 'A
Business Address: V N
"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.
penalties of perjury, I declar t5at I
in it are true.
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Printed Name
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anuary I3, 2024
ry Public Unden�rltwa
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read the foregoing document and that the facts
State 09p, orida County of Dade
The foregoing instrument was acknowledged before me
via C!,fp—hsical presence OR ❑ online notarizations
this , / da of b , 20 2-?,.
By
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Pc,rcn sown ✓ R A6duced identification
IJAIf E A BLANCO- NbCary Public
My emission Expires 01/19/2024