Margarita Kruyff1L A M/B CH
City of Miami Beach
1700 Convention Center Drive
M ia m i B e ach, Fl or id a 33 13 9
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 3 0 5 .6 7 3.7 4 11
RECEIVED
APR 12 2023
C ITY O F M IA M I B E A C H
O F FIC E O F TH E C ITY C L E R K
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY O F MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that appl y):
/ am a resident of the City of Miami Beach for six months or longer.
Home A«tare.. /0g Wye k Ayeyue #l3, Liaw@ 3ea@$/ F_ 33137
□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 ------------------------
P1[[me,S, [\][reS
□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).
[or9 ( [[4g1me$5
[1feS,, [\([]r?S-
"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
ate., :4,° +1\] _if0lo.\}, _.4(0
stoic f (J[{ se
doyq vela tr@E-
Printed
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or n online notarization,
us '1day or. Pe2IL ,2023 , t'again 1oyrt
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
own
c
- iign z T lot; Pub l ic
. 'Hu i To ss V»ren ts
(NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped