Jessica Perez WaleckCity of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@m iam b eachf_gov
Telephone: 305.673.7411
REC EIVE D
FEB 27 2023
CITY OF MIAMI BEACH
O FFICE OF TH E CITY CLERK
A FFIDAV IT O F AFFILI A TIO N W ITH THE CITY O F M IAMI 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):
o I am a resident of the City of Miami Beach for six months or longer.
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a 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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"j?f I am a full-time employee of a business (for a minimum of six months)
Name or osmess. )ho/h tnmnun it9 (@r c ci of fuhh +o ld, In.
usness A4are s. 2 0@ 0 Bjg o 3o ._ FL 33)7 +qat el rprf@nil Jew muifq err'
"Ownership Interest" means the ownership of ten percent (10%) or more {In cl uding 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.
declare that I have read the foregoing document and that the facts stated in it
2-22.2023
Signature
Jessic a Per e z W al eck
Printed Name
NOTARY
siGraue or Noia WuDie_ ,' Doro, ,SAS)oI
m e of ~oi ary, Tc, rnea, Gr sa#
Date
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization, - . ) this 23 day of far .a , _2o23 y. )rs,a ere, (rak ed
" (City of Mi am i Beach Board/Committee Member).
Produced ID
± _Pesso .$""e c on
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