Gerald Schwartz\/14\,\/BF f l hL l.
City of Miami Beach
1700 Convention Center Drive
Mi am i Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email:. BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MA4R 13 20
CITY OF MIAM I BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
r} lam a resident of the City of Miami Beach for six months or longer.
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Home Address_Lcf@_} ye1ctr. y? /-
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□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 or osmess 2 2nymy_ j/pt>
7
Business Address ..- ..,,..... _
I lam a full-time employee of a business (for a minimum of six months) and l am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months). - fare 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. ~
Under penalties of perjury,decof4re Hatt have $ad the foregoing document and that the facts stated in it
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Pfinted Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ysical presence or□online notarization,
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Produced ID
(City of Miami Beach Board/Committee Member).
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Form of Identification
qi, CHARLES J,DAG9TIN
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j,J9,$; xPens: Deemer 14,2025
] '·@z{&?' ponded Thu Notary Public (Underwriters Name "ii.is
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