Joseph MagazineCity of Miami Beach
1700 Convention Center Drive
M iami Beach, Florida 33139
OFFICE OF THE CITY CL ERK
Email: BC@ miamibeachfl.gov
Telephone: 305 .673 7411
RECEIVED
FEB 24 2023
CITY O F M IAMI 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):
E~ lam a resident of the City of Miam i 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}.
Name of Business _
Business Address _
a 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 _
Business Address _
"O w nership Interest" m eans the ow nership of ten percent (10 %) or m ore (including the ownership of
10% or m ore of the outstanding capital stock) in a business.
"B usine ss" m eans any sole pro prietorship, sponsorship, corporation, lim ited liability com pany, or other
en tity or bu sine ss association.
re that I have read the foregoing document and that the facts stated in it
02l23/23
Date 1
NOTARY
________ (City of Miami Beach Board/Committee Member).
/ Produced ID
of Identification
Personal K -
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
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Signature of otary Public
Name of Notary, Typed, Printed, or Stamped