Susan Mirielle EnlowCity of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC @miamibeachfl qov
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
(✓} all that apply):
r3l 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 S�t �C,,,/\ R,
Business Address_ ! "' , T ! �✓�3 3
a 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 BusinessA
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 penal ies of pe iry, I declare that 1 have read the foregoing document and that the facts stated in it
are true.
Sign re Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of 4hysical presence or ❑ online notarization,
this day of 0 A 0a"��, 2077-, by ,Wll �� Z0,Q 16.4
(City of Miami Beach Board/Committee Member). 1�*Y'.��.., MAUREEN ZUNIGA
'/,•��, Notary Public • State of Florida
Commission ; HH 293887
Produced ID `�'� oF�°�; My Comm. Expires tui 27, 2026
Form of Identification Bonded through National Notary Assn.
Pers ally Known
)V60W1ta_11_ Z"t3o (NOTARY SEAL)
Signu of Notary Publ
W4r, FeWy.J1 �/l�
Name of Notary, Typed, Printed, or Stamped