Lauren FosterM IA M I B E H
Ci ty of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 16 2023
CITY OF M IAMI BEACH
O FFICE O F THE CITY CLERK
A FFIDA V IT O F AFFILI ATIO N W ITH THE CITY O F MIA M I BEACH
STA TE 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):
I 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 minimum of six months).
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[[Jg[fess (]]foSS-
□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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P{][fess J(]]fPeS3.
"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
are tru~ ,/ _ _.....;]~_,~ ....... · ·--r____, _
Signature Date
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Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means otphyslcal presence or□online notarization,
ms /coy, mah .a?z » (en_ Ph
(City of Miami Beach Board/Committee Member).
Produced ID
m of Identification
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i,(; com m»sion # H!' ,j, 12024 1g, . Expires 0I ·+ %$, y(Comm._, Notary 4Assn.
1 <anded through Nat/o%
(NOTARY SEAL)
Signature of Notary Publig, ,, rh [cl\I
Name of Notary, Typed, Printed, or\stamped