Herb SosaEmail: BC@miamibeachfl.gov
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
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:___________________________________________________________
□ 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:_________________________________________________________
Business Address:_________________________________________________________
□ 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).
Name of Business:_________________________________________________________
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 are true.
Signature Date
Printed Name
From:Herb Sosa
To:Mena Caceres, Keila
Subject:Re: City Affiliation Requirements for Board and Committee Members
Date:Tuesday, May 30, 2023 12:56:47 PM
Attachments:Affidavit of City Affiliation - Fillable.pdf
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On 5/30/2023 12:33 PM, Mena Caceres, Keila wrote:
Good afternoon Board Members,
You are required to verify your affiliation with the City by completing the attached
Affidavit. This requirement is to confirm that your residential/business address is
accurate.
Individuals serving on a Board or Committee must complete an Affidavit of Affiliation
with the City of Miami Beach once a year.
The Affidavit must be returned to me by June 30, 2023.
Board Liaisons,
Please ensure that your Board/Committee members are completing the Affidavit and
returning it to me.
Thank you.
Respectfully,
Keila Mena, Office Associate IV
OFFICE OF THE CITY CLERK
1700 Convention Center Dr, Miami Beach, FL 33139
Tel: 305-673-7411 / www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,
tropical, historic community.
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