Jean Marie EchemendiaMAI A\l
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305 .673 .7 41 1
RECEIVED
FEB 10 223
CITY Or M orricE o,3,/,Mt BEAc
E CITY OLER
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):
121 I am a resident of the City of Miami Beach for six months or longer.
Home Addre6396 N Bay Rd, Miami Beach, FL 33140
□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 Business ------------------------
Business Address _
121 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 Douglas Elliman
Business Address 1111 Lincoln Road, Miami Beach, FL 33139
"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.
rjury, I declare that I have read the foregoing document and that the facts stated in it
02/08/23
Date
JEAN MARIE ECHEMENDIA
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
he l_ aayor Ee .2o23y _Tea /ate L e e4 A
Produced ID
Form of Identification
Personal! Known
PATRICK D. CAMM
MY COMMISSION # HH 254869
EXPIRES: April 19, 2026
(NOTARY SEAL)
Np9any,Pule
oT6• . op
Name of Notary, Typed, Printed, or Stamped