Laura Weinstein-BermanMI A MI BEA
City of Mi ami Beach
1700 Convention Center Drive
M iam i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl.gov
Telephone: 305.673.7411
RE CE IVE D
M4AR 13 2023
CITY O F MIAM I BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
C O U N T Y O F MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) al l th at apply):
✓I am a resident of the City of Miami Beach for six months or longer.
Home Address l @u _kg- JM1Mt_%4, /133(4/
J
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).
Business Address
□l 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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H[Ag[mes,S, J(Ht]f@SU-
"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~f g rjury, I eclare that I have read the foregoing document and that the facts stated in it
are true, 4, 3/67/
» 940 '20 23
Sig ure Date r I
HNAA L#7RE7NU- BE!am!
Printed Name
N O TA R Y
Sworn to (or affirmed) and subscribed before me, by 1eans of physical presence or□online notarization,
7 /l, . ] ' - s 2cay ot ["l@ ch ,o23%» rg a he
(City of Miami Beach Board/Committee Member).
Produced ID
~
s
Form of Identification
Name of Notary, Typed, Printed, or Stamped
ANN MW WALTZ/KQT AR ! SE AL )
Notery Public · Stat' ~fl~rids
Com m ission HH 199865
My Comm. Expires Jan 12, 2026
Bonded through National Notary Assn.
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