Steffany LancettMI AMI BE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
MAR 3 2023
CITY OF MIAMI BEACH
OFFICE Or Ti cirY CLER
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):
IZI I am a resident of the City of Miami Beach for six months or longer.
Home AddreZ900 Tatum Waterway Dr. Miami Beach FL 33141
Ill 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 Busine3SC Janitorial Services LLC
Business AddresZ900 Tatum Waterway Dr. Miami Beach FL, 33141
□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 declare that I have read the foregoing document and that the facts stated in it
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Signature Date
Steffany E. Lancett
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
es 3la MNUh _.c23 _Sl{Fan, Lnl
(l[/ of Miami Beach Board/Committee Member).
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Signature of Notary Public
Name of Notary, Typed, Printed, or Stamped