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Brad Ugent Sep 2022rvAI AMI BEA Cllr +r MUnI Been 17(b falvcnttm CaBO 1hive MIamI Bach. Fbdtb 311 le OFFICE OF TIIE crrY CLERK Em,U, BQ©mbmlbmCtln,q9v facTjwH: IOS.b7J.74 II n 1 am in t,ompHanc8 w\th the am11auon requIrement of MIamI Beach CItY Code SectIons 2'22 (4>' as (check (/) all that apply): +I am a resld6nt ot the CIty of MIamI Beach lot sIx months or longoF' # 3.4 /”t ..w' FL. , ' # pcI c BBfctO L, Mdns!!“"Sg3 g CO( I .'oS 4d e a I hav6 an wnershlp Interest (for a mInImum of sIx months) in a busIness e8tabllshed In the CIty of MIamI Beach (for a mInImum of sIx months). Name BusIness: at BusIness Address: D I am a full.tIme employee of a busIness (for a mInImum of sIx months> and I am based in an once or other locatIon of the busIness that is phYsIcalIY located in MIamI Beach (for a mInImum of sIx months). Name BusIness: of BusIness Address: -OwnershIp Inter6sr means th$ ownershIp of ten percent (10%) or more (IncludIng the ownership of 10% or more of the outstanding capital stock) in a business. 'Busin$ss- moons any solo propHetorshlp, sponsorshIP, corpor8tion, limIted IIability company, or other entIty or business associatIon. Under penaltIes of perjury, I declare that I hav6 read the foregoIng document and that tho facts stat6d in it are tru8. SIgnature Date 7/1'1 /a;i Lda al–PrInted Name (g &d& y Received July 19, 2022 Office of the City Clerk