Julian LinaresM IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emai l: BC@m iamibeachfl.gov
Telephone: 305.673.7 411
RECEIVED
FEB 10 2023
CITY OF MIAMI BEACH
OFF ICE 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): / 1a a resident of the City of Miami Beach for six months or longer.
Hom e Address 5Gog co[lb No 4 (£ 'la_N fy33{6
a 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 _
c 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).
[Jaffe tf [gs]me$5
Business Address _
"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 o
are true.
t I have read the foregoing document and that the facts stated in it
[a6.[o 2oz2>
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
his lo day or feh ,2o2» l o Laaes
________ (City of Miami Beach Board/Committee Member).
Prosocoa o goo,a + Gd (Lua,Al 5ldco)
Form of Identification
onally Known
PATRICK D. CAMM
NY COMMISSION # HH 254869
EXPI RES: April 19, 2026
(NOTARY SEAL)
Si ature of Notary Public pl }av
Name of Notary, Typed, Printed, or Stamped