Jack BenvenisteMIAMI BEACH
city OF Miami seach
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Miami uacc ' Fltyridin 33139
QFfCE QF TfJJ Cr1Y CLERK
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W*ph;�;: 305 673 7411 -
AFFIDAVIT OF AFFiLIATION WITH THE CITY OF MIAMI BEACH
I am Fn compliance with the affii€iatian requirement Of Miami Beach City Code Seclions 2-22 (4),
as (check t,/1 all that apply)
IR I am a resident o'P the City of Miami Beaich for six months or longer
8075 Noremac Ave, Miami Beach. FI 33141
Home Address_
I have an ownership interest for a trF1nimum a1 sex months) in a business esiahli ed �n the
City of Miami Beach (for a minimum of six months)
Guru Depot
Name of Business..
1 { 18 -B 71 St, M lami Beach, R 33141
BLisiness-Address
L1 1 am a full-time employee ol-a business (fav a minimum of six months) wid I am based irr, an
ogre or other location of the business that is priysicalhy located in Miami leach ftor .a
minimum of fix months)
Name af Busirtes -
Business Address_
'Owneralr�iv lntere&t" mparrs fhe ownership of ten porcenl (10%) or mora (including the
omiership af 10 ry tnom of the outstanding capital stock) in a busy w&S-
`i3F� Sines" mearrs any &cffi prr rWwslaip, spotam rsinp corporafton. limited fiabihty CmPaw
ur purer entity or badness association.
Under penalties of perjury, I declare that I have Tread the fr going document artd 1ha1 the facts
stated in it are true
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Printed Name
May 30 2023
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