Lisa ColeM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
M iam i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 13 2023
CITY OF MI AMI BEACH
O FFIC E O F TH E CITY CLERK
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
()al l that apply):
~ I am a resident of the City of Miami Beach for six months or longer.
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□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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Business Address _
□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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"O wnership Interest" m eans the ow nership of ten percent (10 %) or m ore (including the ow nership of
10% or m ore of the outstanding capital stock) in a business.
"B usiness" m eans y ole proprietorship, sponsorship, corporation, lim ited liability com pany, or other
entity or business sso iation.
, 1. declare that I have read the foregoing document and that the facts stated in it
1/11/2023
Signature
Lisa Cole
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presen ce or online notarization,
ms l_ aay or e0+p, 2 »_L& ol
________ (City of Miami Beach Board/Committee Member).
U Ocpo h Produced ID
Name of Notary, Typed, Printed, or Stamped