Hortense De CastroMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 12023
CITY OF MIAMI BEACH
OFFICE OF TE 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 Section s 2-22 (4), as (check
( ✓) all that apply):
M I am a resident of the City of Miami Beach for six months or longer.
Home Address_y o lo±a, du,, you _(].~_
□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).
[]Qr T HIS[PSS
H[[S][es [\(H]FOSS
[lJI' 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 Busine ss be» kk, Hell.a.oo, He eu,es bl/r_Ra(+y
Busine ss Address_I/l PL,,hip4a.. lye. $3,4 1o5,P1 @
"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 pe~alfe s of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. r 0 (@ t[ \
71 _0/bu_g_ __ _ts_l0 F e_byav·y L,2
Signature Date
+lds ).Ere
Printed Name
NOTARY
Sworn to (or affirmed) an d subscribe d before me, by mean s of phy sical presen ce or u online notarization ,
[" felo go q__,2o2?_by
________ (City of Miami Beach Board/Committee Member).
€?'/\A9/8/AA....0
Produced ID
, J Form of Identification '1... l!2#+3.
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)