Susan Askew/V\IAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CIERK
Email: BC@miamboachf.gov
Telephone: 305.673.7411
RECEIVED
FEB 12023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUN TY 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):
a 1am a resident of the City of Miami Beach for six months or longer.
Home Addres O Island Ave, #407, Miami Beach, FL 33139
] 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 Businoa eanimar LLG
woe
Business Addres 9 Island Ave, #407, Miami Beach, FL 33139
I lam 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 physical ly located in Miami Beach (for a minimum of six months).
[/are tf Py1mes....
Pt4s1fess (]}feSS
"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 enalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
2/3/2023
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of a physical presence or o nline notarization,
o 5 fluay.073 Su5ano #skua
(City of Miami Beach Board/Committee Member).
Notary Publlc Stat ot Ftortdg
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'Hkzisi~~ •• Exp. 7/22/2026 «