Laura TaylorMI/AM[BEACH
City of M iam i Beach
1700 C on v ention Center Drive
Mi am i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
R E C EIVE D
MAR 1 0 2023
CITY O F MIAMI BEACH
OFFICE OF THE CITY CL ER K
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 Section s 2-22 (4), as (check
(/) all that apply):
t lam a resident of the City of Miami Beach for six months or longer.
Hone Asa.,_ \5 fcvw9D o_,Mu@rt
] I have an ownership interest (for a minimum of six month s) in a business established in the City of
Miami Beach (for a minimum of six months).
[Jame (f [Jg]meSS
HJ][9SS, (([@S3
□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).
[]qr f H[jg[fess
1[s]fess J(]Hrs
"O w nersh ip Int erest " m o a n s th e ow nersh ip of ten pe rcen t (10%) or m ore (inclu ding th e own ersh ip of
10% or m ore o f th e ou tstan ding capital sto ck) in a business.
"B u sine ss" m ea n s an y sole p rop rietorship, sp onsorship, corp oration, lim ited liability com pany, or other
en tity or bu sine ss asso ciation .
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
aretrue. ~~ -r:::. 1 2 / leLUr) '2,202 3
Signature Date
a_ fa.nIer
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
________ (City of Miami Beach Board/Committee Member).
Produced ID
_ Form of Identification
L Person ally Kn own
I
, YVONNE G. ENRIQUEZ.
ti 'id MY COMMISSION # HH 257522
%j4.&? EexPREs:.Au9us 20, 2028
%f,1N"
(NOTARY SEAL )