Tim CarrCity of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeach/l.gov
Telephone: 305.673.7411
RECE IVED
MAR 16 2023
CITY OF MIAMI 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):
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l am a resident of the City of Miami Beach for six months or longer. , , , ,)
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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 m7-inimum six months).
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l am a full-time employee of a busine ss (for a mi nim um 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).
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"Ownersh ip Interest" means the own ership 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 lia bility company, or other
entity or business association.
Under penalties of perjury
are true.
lare that I have read the foregoing doc the facts stated in it
Signature a CC
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of } physical presence or online notarization,
oe I3day ow Hach o22 [jm Curt
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Known
Notary Publlc State of Florida
Janiffer Rodriguez
M y Commlssion HH 327629
Expires 10/31/2026
(NOTARY SEAL)
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