Joshua RobinsMl
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE Cl1Y CLERK
Email: BC@miamibeachfi_gov
Telephone: 305.673.7411
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLE
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 Address4316 Nautilus Dr, Miami Beach, FL 33140
□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).
[pQm% (of [/JS/[S.-»
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).
Name of Business Scott Robins Companies, Inc.
Business AddreZ30 5th St, Mi a mi B e a ch, FL 33139
"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.
Under penalti
are true.
~rjury, I declare that I have read the foregoing document and that the facts stated in it
2/15 /23
Signature
Joshua Robins
Date
Printed Name
N O T A R Y
Sworn to (or affirmed) and subscribed before me, by means of ph y sical presence or□online notarization,
this /6 day of'._,/~ , 20&._by w,O•ltJ,?J /44>8/;_;S
(City of Miami Beach Board/Committee Member).
Produced ID 'I! .. -·- ~orm of Identification
l]&it", MARI E ELAINE RODGER {\RY SEAL )
Si [i; A MY COM MISSION # GG 916679 tr"ff<--= jlzgg gs EXPIRES: January 25, 2024
Name of Notary, Typed, Printed, or Stamped "}A.r" ponded Thru Notary Public Und erwrit ers