Joanna-Rose KravitzMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Bench, Florida 33134
OFFICE OF THE CITY CLERK
Email: BC.@miamibeachfl.gov
Telephone: 3 05.673.741 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
(✓) at apply):
c I am a resident of the
?City of Miami Beach for six months or longer.
Home Address �4 ` 1& / W0 'Yvt�`C�I/Y%1 l�C�'GcCA-
L-1 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
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
Business Address
"Ownership Interest" means the ownership of ten percent (90%) or more (including the ownership of
90% 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 tac�.s stated in it
are true. c 2 ,
S&pdure Date
Pr ed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of Li physical presence or Li online notarization,
this Z� day of _d CW) Vfi� !'� 20'43 by �C UCA►1 Ate- 1/I'1 Z
(City of Miami Beach Board/Committee Member).
���aunnuuiu
Produced ID
Form of I ratification �°•��'(WYp!!B'
Personally nown s .•
I r MY COMMISSION
(4OSM027
Signature of N ary P blic
Name of Notary,Typed, Printed or Stamped OFF.;���"•