Seth Feuer�A I A /\ M P1, E A
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: 13C( nniamibeachfl.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):
v,r I am a resident of the City of Miami Beach for six months or longer.
Home Address 1330 West Avenue #804, Miami Beach, Florida 33139
0 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).
Name of Busin
Business Address
,e 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 Seth Feuer P.A.
Business Address 605 Lincoln Road - 7th Floor, Miami Beach, Florida 33139
"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 penalti of p rjury I declare that I have read the foregoing document and that the facts stated in it
are true. ( Z _ 2&-1
Signat Date
Printed Name
NOTARY /
Sworn to (or affirmed) and subscribed before me, by means oft phys'caf-presence or 0 online notarization,
th iS5 day o� r tAC-,I^ � 200-10—%y S \ L4 L lz
Produced ID
(City of Miami Beach Board/Committee Member).
Form of Identification
(NOTARY SEAL)
a ►.'u CHARLES J. DAGOSTIN
MY COMMISSION # HH 165105
EXPIRES: December 14, 2025
•.. gwf ; -O Bonded Tt" Notary Public Underwriters