Larissa CajiaoRECE I VE D
4AR 3 2073
MI AM I BE A CH ID,, niecirri
OFFI- ' -
,·.
City of M iami Beach
,1700 Convention Center Drive
, Miami Beach, Flor ida 33139
4
'' OFFICE OF THE CITY CLERK
' Email:. BC@miamibeachfl.gov
' Telephone: 305.673.7411
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.
Home Address ------------------------
□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).
[]3re ({ [1IS[[@Si_.-
h, Business Address
'P'. ,/:, / , am a full-time em-p-lo_y_e_e_o_f_a_b_u_s_in-e-ss_(_fo_r_a_m_in-im_u_m_o_f_si_x_m_o_n-th_s_)_a-nd-1-am_b_a-se-d-in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
ere or see Lhidad o to m> a ~Lnc.
u se s» Aa«res». 1251 olL Kue. 'arc ea d, pl. 33)41
"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
a v %# .- 03/03/20 23
Signat e Date
an'a arissa @;lao
Printed Name • V
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or online notarization,
ii03%cc Mohl .asp Movie lvco (Cbijio
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________ (City of Miami Beach Board/Committee Member).
co CA 0-5523- 70 598,-0 LL)
Form of Identification
Known
Signatur
et?#tte., Fabiola Estrada
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ff%j{" Bonded Th u Aaron Notary
{NOTARY SEAL)