David SextonM IA M I BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@ miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF 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):
xJ I am a resident of the City of Miami Beach for six months or longer.
IKI 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).
D 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).
"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, I declare that I have read the foregoing document and that the facts
stated in it are true.
~ 3/19/2021 ------------- Signature
David Sexton
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of [}ohysical presence or l online
t ti thi 19thd f March 20 21 b [)[q[[Zqi,]O[]. I[S ld/ Ol ') -
David Sexton ________________ (City of Miami Beach Board/Committee Member).
X Produced ID US Passport
Form of Identification
Personally Known
Ciaotu'7'9et
Signature of Notary Public Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
Charles J. DAgostin
NOTARY PUBLIC
l [sTATE OF FLORIDA
o! (
N -+ comm# G G 168171
' 6' WO Ts" Expires 12/14/2021