Samuel SheldonMAIA M/BE, CH
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 24 2023
CI TY OF MI AM I BE A CH
O FF IC E O F T H E C ITY C LER K
A F F ID A V IT O F A F F ILI A T IO N W IT H T H E C IT Y O F M IA M I B EA C H
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 th at apply):
IZl I am a resident of the City of Miami Beach for six months or longer.
Home Address4434 Po st A ve , Miami B e a ch , 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).
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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).
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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 p lties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are tru e.+ M ). 2/24/23
-------------- Signature Date
S a m u e l M . S h e ld o n
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of g,physical presence or o online notarization, .a al a zo23. am 2L M, Sk(al»
7
________ (City of Miami Beach Board/Committee Member).
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