Laura VeitiaC ity of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.go
Telephone: 305.673.7411
RECEIVED
MAR 13 2023
QTY OF MIAMI BEACH
OFFICE Or THE IrY CLErk
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
S T A T E O F F L O R ID A
C O U N T Y OF MIAMI-DADE
l am in co mp l ian c e with th e affi liation requirem ent of Mi am i Beach City Code Section s 2-22 (4), as (check
(/) all that apply):
IZ1 I am a resident of the City of Miami Beach for six months or longer.
Home Address 1545 Bay Drive, Miami Beach, FL 33141
[] I have an own ersh ip interest (for a minimum of six months) in a business established in the City of
M ia m i B e a ch (fo r a m in im u m o f six m o n th s).
N a m e o f B u sin e ss Urban Resource
B u sin e ss A d d re ss 1193 71st Street, Miami Beach, FL 33141
□I am a fu ll-tim e e m p lo ye e o f a b u sin e ss (fo r a m in im u m of six m o n th s) a n d I a m b a se d in a n office or
o th e r lo ca tio n o f th e b u sin e ss th a t is p h ysica lly lo ca te d in M ia m i B e a c h (for a minimum of six months).
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"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.
U n ~eQ,a!_ ij s of pJ,_·ury, declare that I have read the foregoing document and that the facts stated in it
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-------------- Sin~tgre/\ Date
Laura V eitid
P rin te d N a m e
NOTARY
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