Isaiah MosleyMIAIBE H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
O FFIC E O F TH E C ITY C LERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 24 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 ap pl y):
I am a resident of the City of Miami Beach for six months or longer.
Home AddresO35 Lenox Avenue, #316, Miami Beach, Florida 33139
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).
Name of Business Kate Mosley Design LLC
Business Address 835 Lenox Avenue, #316, Miami Beach, Florida 33139
□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 (fo r a minimum of six months).
Name of Business _
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.
of perjury, I declare that I have read the foregoing document and that the facts stated in it
Feb 24, 2023
Date
Isaiah Mosley
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of a physical presence or o online notarization,
»2 a» Phu . s23»Esa /fogy
________ (City of Miami Beach Board/Committee Member).
Produced ID
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]"[ By, .. on ded through Nation al Not}k} }sh'
Form of Identification
Name of Notary, Typed, Printed, or Stamped