Christine Perrin-StoccoCity of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CL ERK
Em ail: BC@miamibeachfl.go
Telephone: 305.673.7411
RECEIVED
MAR 25 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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 ):
91 am a resident of the City of Miami Beach for six months or longer. . •· . .. . . . . , ··. . . . ft
re .a» 174 •rp1 Sha £ [74yr;$}/''
/ 1 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 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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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 perjury, I declare that I have read the foregoing document and that the facts stated in it e"%hf t (ll l , J4--la b3J2{]2z
Signature Date T 7
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Printed Name
NOTARY J'
Sworn to (or affirmed) and subscribed before me, by means of physical presence or a online notarization,
o2a«ph- at3s. hike f,,a koo
(City of Miami Beach Board/Committee Member).
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Form of Identification
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Notary Public
«!/%4, STEPHEN ARSLANIAN
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Commi ssion # +!H 253132
Expires Ap1# 14, 2026
(NOT ARY SEAL)