Gino SantorioM IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Em ail: BC@m iamibeachf. gov
Telephone: 305.673.7411
RECEIVED
FEB 9 2023
CITY OF MIAMIB Oc or ii 35CH
a CLER K
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):
□I am a resident of the City of Miami Beach for six months or longer.
Home Address _
□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).
[ammo of [1Jg/mess
y]mes J(]fosS-
Iii 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 of Business__po.t a._ _Mel]_ Cele
usmess Aadress. !3o [Lb_ Ld _ML. [el
"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 eclare that I have read the foregoing document and that the facts stated in it
are true. g[7413 _........;. _
Signature
Ana1.ale
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or u online notarization,
o 1a oat«lurL.a2 » Qo ofovu
_ (Cii/of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Name of Notary, Typed, Printed, or Stamped
a«kl#L...
EXPIRES: January 22, 2027