Brian EhrlichM IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673 7411
RECEIVED
FEB 14 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERR
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in com pliance with the affiliation requirem ent of Miam i Beach City Code Sections 2-22 (4), as (check
(/) all that apply): X' I am a resident of the City of M iam i Beach fo r six m onths or longer.
ore. ow .. 5 I6lual Neg Mgr, lIH H ui Bel!f7,
{ 1n ave an own ersh ip inter e st (tor a minimum ot stx month s) in a busine ss est ablish e d # 4 . ,2If
("".. M iam i Beach (fo r a minim um of six m onths).
Name of Business _FGU:aJ ~
re.. 'I o 'Rs4d Hued, Eeall 33iy
□I am a full-tim e em ployee of a business (for a m inim um of six months) and I am based in an office or
other location of the business that is physically located in M iam i Beach (fo r a minim um of six months).
Nam e of Business _
3JS[fess (]]resS
"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.
P rinted Nam e
eclare that I have read the foregoing docum ent and that the facts stated in it
21 223
Date
NOTARY
S worn to (or affirm ed) and subscribed befo re m e, by m eans of□physical presen ce or online notarization,
_________ (City of Mi am i Beach Board/Com m ittee M em ber).
/ Pr o duced o Tl lo en-&€
)~tification
Personally Kn'[._r--f"- _
Si gnature of Notar y P ublic