Mark RabinowitzMIAMI/BEA H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.7411
RECEIVED
FEB 21 2023
CITY OF MIAMI BEACH
OFFICE OF 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):
□I am a resident of the City of Miami Beach for six months or longer.
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□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).
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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 Miami Beach Community Health Center, Inc.
Business Address 710 Alton Road, Miami Beach, 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 penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true a._l...: February 20, 2023
Signature 7
1 DIANA L HERNANDEZ
Mark Rabino witz ay Pubic · Sate ' Florida
Commission # HH 345581
Printed Name .amm, Expires Jan 3, 2027
NOTARY gh National Notary Assn.
Sworn to (or affirmed) and subscribed before me, by means of physical presence or a online notarization,
us.U aay or _fbraw y_ ,2o23_y Murk Kobiowirz
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Personally Known
~·· (NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped