Jeffrey RynorCity of Miami Beach
1700 Convention C e nter Drive
Miami Beach , Flor ida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAY 17 2023
CITY OF MIAMI BEACH
OFFICE OE TAP CITY CLERK
A FFID A V IT O F A FF ILI A T IO N W IT H T H E C IT Y O F M IA M I B EA C H
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.
e .oar. sse Ii L,'rd
□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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osmess Address <7\ Eb-)hit«; litter(cl. (« ,H90
Rho«e,' .>Zi(co
) lam a full-time employee of a business (for a minimum of six months) and l am bas@d in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
Name ot business _ A, aloe
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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.
0...-7.. 27 Under pena7~7wdury,I ~!P.te""fl~~tfa~~ad the foregoing document and that the facts stated in it e, YUe£,(£,, > • Y LL. ,la . = soi9 , »» 7
tiller fps Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or on line notarization,
st aor ottoj _.aoE»_ ,krc-j @pro
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
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Name of Notary, Tped, Printed, or Stamped