Peter MatosMIAMI BEAC 11
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC(Qmiamibeachfl.gov
Telephone: 305.673.7411
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):
1 am a resident of the City of Miami Beach for six months or longer.
Home Address 1465 Cleveland Rd, Miami Beach FL 33141
❑ I have an ownership interest (for a minirnum of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
Name of Business
Business Address
p' 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
Business Address
"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 penalties of perjury, I d Glare that I have he foregoing document and that the facts stated in it
are true. 1 /9/23
/Peter Matos/
Signature w... Date
Peter A. Mato& -
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
this Tday of Atou(_A2023 by °frit C j
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Peri ly Known !
Signature of IlOtary PublicI,
Name of Notary, Typed, Printed, or Stamped
NANCY CABRERA
Notary public - State of Florida
of°aA� H 0_11782
My Conm�ExpireHehi9,2025
of' Pd through National Notary Assn.
(NOTARY S A