Frank MenaMI AM I BEA CH
City of Miami Beach
'700 Con v ention Center Drive
Mio»i Besch, Flor ido 33139
OFFICE OF THE CITY CLERK
Email BC@miamybeachf] qoy
Telephone: 305 673.711
RECEIVED
FEB 27 2023
CITY O F MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDA VI T OF AF FILIATI ON WI TH THE CITY OF MIA MI BEACH
STATE OF FLORIDA
CO U N T Y O F MI AMI -DA D E
l am in compliance with the affiliation requirem en t of Miami Beach City Code Sections 2-22 (4) as (check
(/) all that apply):
lam a resident of the City of M iami Beach for six months or long er.
Home Ad&res 1621 Collins Avenue, #1005, Miami Beach, FL 33139
D I have an owner s hip interest (for a minimum of six months) in a business establishe d in the City of
Miami Beach (for a minimum of six months).
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[1PS, J ([{]f@ S b_o«
) lam a full-tim e employee of a business (for a minimum of six months) and l 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 mo re ot the outstanding capital stock) in a business.
"Business means any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
U nder penalties 3/ perjury, I declare that I have read the foregoing document and that th e fact s stated in it
"""22 a
Signature Date
Frank Mena
Printed Name
NO TARY
Sworn to ( or affirmgd) and subscribed before m a, b means of o physica l pre se nce or~nHoe notar iza tion ,
»)a do. _G . t..L en.
-(City of Rliami [each Board/Committee llember) pd.t.dot,d.t.l...t.4
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Sig natu re of Notary PubHc ~ . \J .,1-; .
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Name of Notary, Typed, Pinlell,' or Siaimped