Eddie SierraMIAM IBE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
FEB 14 2023
CITY OF MIAMI BEACH
OFFICE OF TE CI TY 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):
□I am a resident of the City of Miami Beach for six months or longer.
Home Address _
ij 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_ o Flor«d +s_ r.[p c_'Lg
Business Address @3 Si O< Lac , °
□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).
Name of Business ------------------------
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.
s of perjury, I declare that I have read the foregoing document and that the facts stated in it
2\4\23
Signature
C_delta 'Sec
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
LJA , ;9, _2,4.45e yo,,- , this _,..,_.llioay of +c.lV ,v......- q- , 2o_~_by _~~~_V_l_'--' __ 'b_ ·_v_ T_ T_ ...... '- _
_________ (City of Miami Beach Board/Committee Member).
produced ID
Pers lly Kn
Signature of ary Public
Name of Notary, Typed, Printed, or Stamped