Ami GlottmannM IA M I B EA C H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 1 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 apply):
t I am a resident of the City of Miami Beach for six months or longer.
560 Lakeview Drive
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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 ------------------------
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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 penalties of perjury,_I declare
are true. '
Am i Glottmann (b 4l\on
hat I have read the foregoing document and that the facts stated in it
28 February, 2023
Signature
Ami Glottmann
Date
Printed Name
N O T A RY
Sworn to (or affirmed) and subscribed before me, by means o~sical presence or□online notarization, . P ..wr le loft a u
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Produced ID
City of Miami Beach Board/Committee Member).
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• }] .gig., CHARLES J. DAGOSTIN $9""" MY COMMISSION # HH 165705
• ' k}i"?}}gdis;;i EXPIRES: December 14, 2025 [OTARY SEAL)
Signature of ";j@$" Bonded Tru Notary Public Underwriters
Name of Notary, Typed, Printed, or Stamped