Curt DyerI i
AN 1..._.
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC(amiamibeachil.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):
p 1 am a resident of the City of Miami Beach for six months or longer.
Home Address 5900 Alton Road, Miami Beach, Florida 33141
El 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 Southeast Bankers Mortgage Corp.
Business Address 1666 79th St. CSWY #505, North Bay Village, FL 33141
p 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 Business
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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. _ --- 01/12/2022
Signature Date
Curt W Dyer
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or n online notarization,
this (? day of AWu.v-�A ,20�a_by QCT
(City of Miami Beach Board/Committee Member).
Produced IQ N (- -bC tV lrs L U
r4 Form of Identification
L -111 -Lk Va i a 4 -It vq tRRJ
Name of Notary, Typed, nted, or Stamped
¢:. CLAUDIA HUGHES
Notary ?uoiit • State of Florida
Commission 4 HH 168988
My Corrm. Exoires Nov 17, 1025
BondeC through National Notary Assn.
(NOTARY SEAL)