Ricardo BarbozaIAMIB H
Ci ty of Miami Beach
1700 Convention Center Drive
Miam i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.7411
RECEIVED
I4AR 21 2023
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OFFICE OF
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA CH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in com plian ce with th e affiliation requirem ent of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that app ly):
ti lam a resident of the City of Miami Beach for six months or longer.
1500 Bay Rd. Apt. 1018 Miaimi Beach FL 33139
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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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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).
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"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 ««vet2 w"
Signature" t Date
Ri car d o B ar b o za
Printed Name
NOTARY
Sworn ~or affirmed) and subscribed before me, by means of ~hysical presence or a online notarization,
ms 5'y ot. 1\B R CH a02 y SL aa)ho
(City of Miami Beach Board/Committee Member).
Produced ID u Form of Identification