Cynthia EsquivelMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: EIC@miamibeachfl.gov
Telephone: 305.673.741 1
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(J) all,that apply):
�am a resident of the City of Miami Beach for six months or longer.
Home AddressC,
p I have an ownership interest (for a m1limurn of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
Name of Busin
Business Address
❑ 1 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 B
Business Address
"Ownership Interest" means the ownership of ten percent (1091o) 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.
der penal/'es of er' ry, I declare that I have read the foregoing document and that the facts stated in it
�rj __4trul�� l —Y-2-3
ignature Date
Cynthia Esquivel
Printed Name
NOTARY \
Sworn to (or affirmed) and subscribed before me, by means of physical presence or ❑ online notarization,
thisnday of ' L 20by
(City of Miami Beach Board/Committee Member).
.n +R�!ir"v' FERNANDA SILVA
v Produced ID Rc*; , A NRS W I?t S L- I ce N)sS< o�5 Mr COMMISSION MHH259547
Form of Identification .reo;�,oa• EXPIRES:August 27,2026
P onally Known
(NOTARY SEAL)
Sigpature of Notary Public
1 E. iz \\A ba ��,tQ
Name of Notary, Typed, Printed, or Stamped