Carolina Boladoiviu/\j«BEACH
CiNy o f Mia m i Bea ch
17 00 Conven tion Center Dr ive
Miomi Beach, Florido 33139
OFFICE OF THE CITY CLERK
Ematt: BG@muamibeachf, gov
Telephone: 305.673.7411
RECEIVED
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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): e am a resident of the City of Miami Beach for six months or longer.
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o I have an ownership interest (fo r 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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o 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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H11ms, J(]}fess.
"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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Signature Dal 1
Carlina 1. Bol ado
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or online notarization,
mu5/ day t JAQ Aey_ ,20?3_y AAe)A O Ao
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Signature of Notary Public
L IDA _7zoo
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)