Jonathan FrydMIA MIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
RECEIVED
FEB 14 2023
CITY OF MIAMI BEACH
OFFICE OE THE 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
(/) all that apply):
/ am a resident of the City of Miami Beach for six months or longer.
Home dare._D_ 0__ _of
/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 or usess_ f Cps(6/4gq«. -
Business Address 22 led ,_n) Al
4am 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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"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" m eans 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 "z; >1- Date
._Jo)4S {4o
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ¥'physical presence or D online notarization,
this ] day or _Euro,, _20ZyJaof1 r, d
(City of Miami Beach Board/Committee Member).
Produced ID
} Form of Identification
Personally Known
ca.de =ET
CHRISTINA M FERENO
Commission #HH 51997
My Commission Expires
October 8. 2024
(NOTARY SEAL)
Signature of Notary Public
Name of Notary, Typed, Printed, or Stamped