Aimee KamatM 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 22 2023
Q/TY OF MIAM I 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.
[ff]e l(]f]fess
□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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/1 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 ot Business. /\TPQ v1A
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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" means any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
Under pe
are true.
ies of perjury, I decl re that I have read the foregoing document and that the facts stated in it
o2/· 20 3
Signature
±inc. k»or
Date
lied Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of y physical presence or online notarization,
ms [t day or. EE 20Zy fm Kant
-------- (City of Miami Beach Board/Committee Member).
Produced ID y Form of identification EE- Si~e of .Notary Pu ic • hill~n ustu
a, JILLIAN GUSTIN
; Notary Public
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CE TS Expires 5/23/2026
Name of Notary, Typed, Printed, or Stamped