Randy WeisburdMIAMI 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
CITY OF MIAMI BEACH
OFF ICE 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):
I am a resident of the City of Miami Beach for six months or longer.
Home Address. 7Lato guy , I\iii_(ec , F 33l 4o
□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).
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Hy[hes,S, ](]fess
□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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"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 pen
are true.
Signature
that I have read the foregoing document and that the facts stated in it
s]al22
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or o online notarization,
this ig"" day ot Ye 202..., b \Za.Y\ckA_ ~~Sc:t> rd
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_________ (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
_ Personally Known
SR=
Name of Notarv. Tvoed. Printed. or Stamoed
Notary Public State of Florida
4 Victoria Sanchez
4 My Commission HH 349974
4 Expires 1/17/2027
(NOTARY SEAL)