David Adams (2)MIAMI BEACH
City of Mic'mi death
1700 Convention Center Drive
Miami Bead, Florida 33139
OFFICE Of THE CITY CLERK
Email: 13CQmiam1-beaQhfl&m
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 (J) all that apply:
EI/I am a resident of the pity of Miami Beach for six months or longer.
Home Address: I Z\6+1 A lo�
El 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:
El 1 am a full-time employee of a bu
office or other location of the b
minimum of six months}.
NameBusines&
Business Address:
siness(for a minimum of six months and t am based in an
Business that is physically located in Miami Beach (for a
"Ownership Interest" means the ownership of den percent (10%) or more (including the
ownership of 10% or more of the outstanding capi#al stock) in a b usiness.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of penury, t declare that
stated" it are true. �
Signature
-1
rX
Printed Name
have read the foregoing document and that the facts
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Date