John AlemanMifiMi BEACH
City of Miami Beach
1700 Convention Center (Drive
Miami beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC0.miamilbeachfl,goy
Teloph one: 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):
p 1 am a resident of the City of Miami Beach for six months or longer.
Home Address5824 Alton Rd. Miami Beach FL 33140
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 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/a 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, 1/12/2023
rrr ut"
Signatu .,_7 Date
John Elizabeth Aleman
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of :.3 physical presence or o online notarization,
this tom-- day of O.A r , 20 by .TO(\ r1 fl g
(City of Miami Beach Board/Committee Member).
_ Produoed 0
Form of Identification
anally Known
Si ature oPu Ii �AY2� I I 281375
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Y .y :!arc: potpber 15.2028
`"`�` EXPIRES
Name of Notary, Typed, Printed, or Stamped «�