Martin Zaiac Sep 2022MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: Bim am--6ea,hfl�
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATIO14 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:
❑ 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:
Bysirtess Address:
[7' 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).
G•-4.
Name of
Business
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"Ownership Interest" means the ownership of ten percent (10%) or mon: (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 u 'ness association.
Under penalties of p lu re that I have read the foregoing document and that the facts
stated in it are tru .
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Signa a nL Date /
Printed