Shaye GuttenbergMIAMI BEACH
City of Miami Beach
17 00 C onvention Center Dive
Mi ami Beach, Florida 33139
RECEIVED
APR 24 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@mniamibeachfl gov
Telep h one' 30 5 67 3.7 4 11
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirem e nt of Miami Beach City Code Sections 2-22 (4), as (ch eck
(/) all that apply):
p lam a resident of the Ci ty of Miami Beach for six months or longer.
Home Address 4307 Alton Rd. Miami Beach, FL 33140
] I have an ownersh ip interest (for a minimum of six months) in a business establish ed in the City of
Miami Beach (for a minimum of six months).
Name of Business, _
[Py]f@,, (JJf@S-
lam 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).
[Jaff% ()f Pt4,1neS.-
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 0=3; declare that I have read the foregoing document and that the facts stated in it
""" 4d [ waoa Signature Date
Seth Guttenberg
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of -~ysical presence or o online notarization,
~
he.2'} day cot pk, 7
________ (City of Miami Beach Board/Committee Member).
D · Produced ID
Form of Identification
«+st4, Marlanela Amenta
.,~~_<M ~"' NOTARY PUBLIC
j h $grr or FLORIDA
2k_{3- 6emmw GG311467
drn ~° @ires 7u9/2023
(NOTARY SEAL)
Signature of Nota
+)ca etc
Name of Notary, Typed, Printed, or Stamped