William WarrenM IA M I BEACH
City of Miami Beach
17 0 0 C o nven tio n Center Drive
Miami Beach, Florida 33139
RECEIVED
FEB 24 2023
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
CITY OF MIAMI BEACH
OFFICE O THE CITY CLERK
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 mo ths or longer.
or- Aware»s. ?e 4 4 zz f4a a, 53Ir
h 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 si 1onths).
lame of BusinesSL' II, ht )l " ' d'
ousmess Address [; s5$1y fr" tilt ft "ziLt fa »
□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).
[Jar9 (f [Jg1fess
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.
f99fjuy, I declare that l have read the foregoing document and that the facts stated in it gt ± uz>
Printed Name 1
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
he ?{ aay a arr2, 2023 y vi]hon Jr
________ (City of Miami Beach Board/Committee Member).
roauceat t by(SCoe-
Signature of N
Name of Notary, Typed, Printed, or Stamped