Amy OstroffC ity o f M ia mi B e a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
RECEIVED
MAR 13 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
Telephone: 305.673.7411
AEEIDAIT OE_AEEILIATION WITH THE CITY OE 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):
p lam a resident of the City of Miami Beach for six months or longer.
Home Add4524 N. Michigan Ave., Miami Beach, FL 33140
□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).
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□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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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.
hat I have read the foregoing docu1ni an7d that the facts stated in it
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Signature Date
Amy Ostroff
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of t/physical presence or a online notarization,
as{la [bf Mo'l 033
(City of Miami Beach Board/Committee Member).
Produced ID
x/ Form of Identification hue
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Name of Notary, Typed, Printed, or Stamped
MELISSA RAMOS
Notary Public • State of Flori
Comm ission # HH 17163