Daniel Nagler1\1Al
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLER K
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 3 2023
CITY OF MIAMI BEACH
OF FICE OF THE CITY CLER K
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STA T E O F FLO R ID A
C O U N T Y O F M IA M I-D A D E
I am in com pliance w ith the affi liation requirem ent of M iam i Beach C ity C ode S ections 2-22 (4), as (check
(/) all that apply):
Tam a resident of the City of Miam i Beach for six months or longer.
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□I have an ownership interest (for a minimum of six months) in a business established in the City of
M iam i Beach (fo r a m inim um of six m onths).
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□I am a full-tim e em ployee of a business (fo r a m inim um of six m onths) and I am based in an office or
other location of the business that is physically located in M iam i Beach (fo r a m inim um of six m onths).
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"O w nership Interest" m eans the ownership of ten percent (10%) or more (including the ownership of
10% or m ore of the outstanding capital stock) in a business.
"B usiness" m eans any sole pro prietorship, sponsorship, corporation, lim ited liability com pany, or other
entity or business association.
Under penalties of perjury, I declare that I have read the foregoing docum ent and that the facts stated in it "" Qa/a s,- _ells
S ignature / Date
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Printed Nam e
NO TA R Y
Sw orn to (or affi rm ed) and subscribed before m e, by m eans of□physical presence or□online notarization,
G ul a r Ar
(([[/ of M iam i Beach Board/C om m ittee M em ber).
2 ✓Produced ID
For~ion
Nam e of Notary, Typed, P rinted, or Stam ped