Lymari VelozMIAMI 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 3 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF F L O R ID A
COUNTY OF M IA M I-D A D E
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
a I am a resident of the City of Miami Beach for six months or longer.
[m e (JI,bj.
•tr 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 or Business_ [ea_ (A_ \\An¢ S«lo
Business Address. Lo3 }]o kn y,at_t 3157
□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).
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"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 penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
e '2A 1,x- 2/z/23
Signature T Date
4 I A, \Vtz
Printed Name
t
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
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_________ (City of Miami Beach Board/Committee Member).
/ roauceam Pt O ve tLyg rAC
r f Identification
Person
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Signature of N blic
Name of Notary, Typed, Printed, or Stamped