Mike GibaldiMI AMI BE H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 10 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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):
am a resident of the City of Miami Beach for six months or longer.
Home Address 478o Pe[g )y<th] Ao K ) )
□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 _
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).
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.
Jpe
/ w~tr
Signature
Mike Gibaldi
Printed Name
that I have read the foregoing document and that the facts stated in it
310_2
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by me~□physical presence or o online notarization,
sunder or Moh zo23 ,Mont 3bld
(l[/ of Miami Beach Board/Committee Member).
/ eoaceea bone
For ntification -
Signature of Notary Pu
Name of Notary, Typed, Printed, or Stamped