Raquel PachecoMI A MI E A
City of Miami Beach
1700 Convention Celer Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibe ach f.gov
Telephon e: 305.673.7411
R EC EIV ED
FEB 92023
CITY OF MIAMI BEACH
OFFICE OF THE CI T Y CLERK
A FFID AV IT O F AFFILI ATIO N W IT H THE CITY O F M IAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DAD E
I am in compliance with the affiliation requirement of Miami Beach City Code Section s 2-22 (4), as (check
(/) all that apply):
1ZJ I am a resident of the City of Miami Beach for six months or longer.
Home Address 732 Lenox Ave, Unit B1, 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).
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I lam a full-time employee of a business (for a minimum of six months) and l 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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"O w ne rship Interest" m ean s the ow nership of ten percent (10%) or m ore (including the ow nership of
10 % or m ore of the outs tan din g capital stock) in a busin ess.
"B u sine ss" m e an s any sole pr o pr ietors hip, sponsors hip, corp oration, lim ited liability com pany, or other
en tity or b usiness association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it " -n» -- a si@nae ae
Raquel Pacheco
Printed Name
NOTARY
Sw orn to (or affirm cd) and subs cribed bcfore me, by moans of ph ysical presence or r online notarization,
«.%a feM@y o3 qoe! YaLo
(City of Miami Beach Board/Comm ittee Member ). ..z Produced D e e
(NOTARY SEAL)
GARY 27A ZELAYA
Co fsslon # HH 231811
wires June 28, 2028