Joshua LevyMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: 13C(cDmiamibeachfI.gov
Telephone: 305.673.741 1
RECEIVED
JAN 2 6 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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 I that apply):
I am a resident of the City of Miami Beach
mfor six months or longer.
Home Address -ro � 3 11. �AyP-\- 6 , �T 3-� r C4, 0
nVII 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 Addres
LP A- v j�\ CA
❑ 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 LItieo� ' clare that I have read the foregoing docuenand that the facts stated in it
are tru
Signata Dates
Josh a Levy
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o�ysical presence or ❑ online notarization,
this'�"�P day of ( 20�"�by ���
M.
(City of Miami Beach Board/Committee emper).
/--& -n
Form of Identification
Vol
IW CHA L J.D OS
MY COMMISSION 0 HH 185705
EXPIRES: December 14, 2025
Boded Ttuu Notary Public Underwrders