Daniel Robles (2)Email: 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 (ض) 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 Namee
5838 Collins Ave Apt. 6E Miami Beach FL 33140
BlackOak Capital Group
5838 Collins Ave Apt. 6E Miami Beach FL 33140
Daniel Robles 5/30/2023