Josephine ManningMI A\Ml
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
EcEivED
6APR 05 2023
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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):
kK 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 minimum of six months).
Name of Business \..,,....,_,,1-'<--+-tF.--------------------
Business Address _
□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 physical) ' located in Miami Beach (for a minimum of six months).
Name of Business -------,c---'<a-------------------
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 perjuy, I declare that I have read the foregoing document and that the facts stated in it
age Ao@u1 //5/2.3
Sig ature Date
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NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
one.&b ay or_bpi\ _ooh 1we Mannln4
(City of Miami Beach Board/committee Member). s"MM5f", Eo, PO rs»vi«a. » Produced D LOLhn: l $ yo «6 £
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%l:/ NUMB?i ""uiiiu«@ijw Name of Notary, Typed, Printed, or Stamped