Elba MachadoM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florid0 33139
OFFICE OF THE CITY CLERK
Email: BC(@miamibeachfl.go
Telephone: 305.673.7411
RECEIVED
FEB 3 2023
CITY OF MI AM I 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
(/) all that apply):
□l am a resident of the City of Miami Beach for six months or longer.
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□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).
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✓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 or easiness._ V R_7AU! _ooP [o//Lgy/Q
osmess Address_ 44t0 At)or00 4-__[yj /etc- p 33,313$
"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
".. eve Signaturs , Date
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of a physical presence or tu online notarization,
this 2,2 day ot_f or }
(City of Miami Beach Board/Committee Member). (
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0. f.< i I@ I< L t c !f7 /V 5?; /Im_ 1%\ Notary Public . State of Florida
Form of Identification #gin ii commission # HH 019932
nown ?(f$ y comm. Expires Nov 7, 2024
"gonded through National Notary Assn,
Signal 'ublic
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Name tary, Typed, Printed, or Stamped
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