Oscar LlorenteM IA M I BEACH
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
HECEIVED
APR 07 2023
CITY OF MI A MI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST A T E O F FL O R ID A
C O U N T Y O F M IA M I-D A D E
I am in co m plia n ce w ith the affi liation requirem ent of M iam i Beach C ity C ode S ection s 2-22 (4), as (check
(/) all that ap ply):
□I am a resid e nt of the C ity of M iam i Beach fo r six m onths or longer.
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□I have an ow nership interest (fo r a m inim um of six m onths) in a business established in the C ity of
M iam i Beach (fo r a m inim um of six m onths).
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I am a full-tim e em ployee of a business (fo r a m inim um of six m onths) and I am based in an office or
other locatio n of the business that is physically located in M iam i Beach (fo r a m inim um of six m onths).
N am e of Business Mount Sinai Medical Center
Busine ss A dd ress 4300 Alton Road Miami Beach FL 33140
"O w nership Interest" m eans the ow nership of ten percent (10%) or m ore (including the ow nership of
10 % or m ore of the outstanding capital stock) in a business.
"B usiness" m e s any sole pro prietorship, sponsorship, corporation, lim ited liability com pany, or other
en tit or bus in 'ss associa tio n.
hat I have read the fo regoing docum ent and that the fa cts stated in it
02/09/23
D ate
Oscar Llorente
Printed N am e
NO T A RY
Sw orn to (or affi rm e d) and subscribed before m e, by m eans of«ph ysic al pre sen ce or online notarization ,
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________ (C ity of M iam i Beach Board/C om m ittee M em ber).
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