Linsey LovellMIAM I BEACH
C ity o f M ia m i B e a ch
17 0 0 C o nventio n C enter Drive
M ia m i Beach, Florida 33 13 9
O FFIC E O F TH E CI TY C LERK
Email: BC@miamibeachfl. gov
Telephone: 30 5 .6 7 3 7 4 11
RECEIVED
MAR 2 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):
)(' I am a resident of the City of Miami Beach for six months or longer.
rome Aaress (245 Meua.wt hu e #k (o, 33121
□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 _
"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 decl re that I have read the foregoing document and that the facts stated in it
are true.
Signature
Printed Na~
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
s Lwlaay or _M ah_ _zo22 sy. LnfCo, Loy el]
.(City of Miami Beach Board/Committee Member).
/ ea±ea ft_Ory2 Lan
or of Identification
Pers
•
Name of Notary, Typed, Printed, or Stamped