Enilda ThomasM IA M I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@mniamibgachfl aoy
Telephone: 305.673.7411
RECEIVED
FEB 13 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
CO UNTY OF MIAMI-DADE
I am in com pliance with the affi liation requirem ent of M iam i Beach City Code Section s 2-22 (4), as (check
(/) all that apply):
lam a resi den t of the City of Mi am i Beach for six m onth s or longer.
Hom e Addrea3800 Collins Ave. apt 1106 - Mi am i Beach FL 33140
□I have an ow nership interest (for a m inim um of six m onths) in a business established in the City of
Mi am i Beach (for a mi n im um of six m on th s).
Nam e of Business. _
Business A ddress _
pl lam a full-tim e em plo yee of a busine ss (for a mi nim um of six m ont hs) and I am based in an offi ce or
oth er location of th e business th at is ph ysically located in Mi am i Beach (for a minim um of six m on th s).
Nam e of Business EHDOC Council Towers South
Busin ess A dore 3 3 Collins Ave. 2nd Floor - Office - Mi am i Beach FL 331 23 1
"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 an y sole p ropr iet o rs h ip, sp onsorship, corporation, limited liability com pany, or other
entity or business association.
Und er penalties of perjury , I declare th at I have read the fore going docume nt and th at th e facts stat ed in it
_"yo±. l.. 210%%°
Si gnat ure Date
ENILDA F TH OM A S
Printed Name
NO TA RY
Sw orn to (or affirm ed) and subs cribe d before m e, by means of p hysical presence or on lin e notarization,
me.I2 atey ot hebay _.zo2 soy. el)le £ tho pas
(City of Miami Beach Board /Com m ittee Member).
Pr o duced ID
A ntifi cation
,M t, SIXT0 ANTONIO ACEA ·<<sf, ctarv Public · Stat e of Florda ;f;i rinse @jg
M , Comm . Ex ires M ar 28, 2023
30rcec through Natior al Notary Assn.
(NOTARY SEAL)
Signature of Nopry Public )to Hl o 'ce o
Nam e of Not a ry , Typ ed, Pr int ed, or S tam p e d