Gabriel PaezMl/AMI/BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
MAR 2 2023
CITY OF MIAMI BE orice iiie ch#v%
AFFIDAVIT OF AFFILIATION W ITH 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 (·) 3/ that apply):
ef I am a resident of the City of Miami Beach for six months or longer.
one Aaares_too Lino.u toad (t,3e /cog 'taazd_ 33131
□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).
[]qr f 11[/eS5
Business Address -----------------------
□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).
[par9 (f [11g1/eS
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.
ead Jh e foregoing documen t an d that the facts stated in it
/b 2.282
l [} l it1
Unde
are tr
signature ()
(6«but ~. f~ea
Date
Printed Name
NOTARY
Sworn to (or affirm ed) and subs cribed before me, by means of u phy sical presenc e or u online notarization ,
» 2or Mach ,asz3 6abnel se f.a - ________ (City of Miami Beach Board/Com mittee Member ).
_U Produced r9L_
Form of Identification
rsonally Known
» Ml#% pi:?i, 3en9! « ;AL) 8 6 comirii.: $4».ii~ Expires: January 24, 2027
2ifs 4oiary Public - State ot Florida "qt' "I