Merle ShamaM\1A1 BEA
City of Miami Beach
1700 Convention Center Drive
M iam i Beach, Florida 33139
O FF IC E O F TH E C ITY C LERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
RECEIVED
MAR 6 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY OLER
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.
ore.nos. I 1sod e ue,#f 1),/iai each, Fl ss3@
□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. _
PIS,/[es,S, (]]feS-
□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).
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[/I,/[e,S, J(](Hf@S
"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.
dare that I have read the foregoing document an
0
Signature
_/er @hair@ el sol4o Printed Name l /f\/'
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of_~ysical presence or o online notarization,
a'Mau eh ] cle Sh4
________ (City of Miami Beach Board/Committee Member).
Y so F y e+fat/oNu (CD)
Form of Identification
Name of Notary, Typed, Printed, or Stamped
CHARLES J. DAGOSTIN(NO] (ARY SEAL)
MY COMMISSION # HH 165705
EXPIRES: December 14, 2025
Bonded Thru Notary Public Underwriters