Mark SinnreichCity o f M iam i Beach
17 00 C onvention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.go
Telephone: 305.6 73.7 4 11
RECEIVED
FEB 8 2023
CITY OF MIAMI BE A CH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST ATE 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):
I la m a resident of th e City of Miam i Beach for six months or longer.
Home Adares 2231 Fisher Island Dr Miami Beach FI 33109
] 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).
N am e of Busine Extremity Preservation, Inc
Business Address 2231 Fisher Island Dr Miami Beach FI 33109
DI 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 physically located in Miami Beach (for a minimum of six months).
f/are t [[1g1/%S8G-
g [[fess, Jdfes}
"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
a°)ta€ 5no«c, PD> February 7, 2023
Signature
Mark Sinnreich, MD
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of sf physical presence or online notarization,
a ]"a or Februrl2023y Plr Sinnrreih MAD
I
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Personally Known
@ii. ILEA+A GARCIA Sr-i, Notary Public • State of Florida 5 A .3 gf; fr ;i Commission # HH 233444 225$8$% wwy comm. Excites Fe 27, 2026
" anded through National Notary A5s0.
(NOT ARY SEAL)
Signature of Notary Public
.L I&An a a r c4 A
Name of Notary, Typed, Printed, or Stamped