Mark Weithorn (2)A A 14, - T
IV � N BEACH
City of Miami Reach
1700 Convention Center Drive
Miami Beach, Florida 33134
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfi.gov
Telephone: 305-673.7411
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):
X 1 am a resident of the City of Miami Beach for six months or longer.
Home Address: 1130 Stillwater Drive
❑ 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 (14/) 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.
-- May 30, 2023
Si nature
lark Weithorn
Printed Name
Date