Beatriz HermannCiy o€ Nini lech
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CL ERK
Email:
Telephone: 305.673.7 411
RECEIVED
FEB 72023
CITY OF MIAMI BEA CH
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 Section s 2-22 (4), as (check
(/) all that apply).
~ I 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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a 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
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Si@nair. Date
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presenc e or on line notarization,
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2Pl< (ciy or Marv Beach Boara/committee Member ).
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Signature of N tary Public
Name of Notary, Typed, Printed, or Stamped
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MY COMMISSION
EXPIRES 1-3.2027
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