Mark SinnerichI AM'I B EACH
City of Miura*[ Beach
1700 Convention Center [give
Miami Beachf Florida 331,39
OFFICE OF THE CITY CLERK
Email: l3c@rniambe,ach
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):
2 I am a resident of the City of Miami Beach for six months or longer.
Home Address:.-Z�3
-�sl��_,'Trl�nd �Or� Mt�� I ��.-��
El I have n wnrs interest(for minimum six months I business established 1n the
City of Miami Beach (for a minimum of six. months).
Name of Business ;
Business Address:
F-1 I am a full-Ume employe 4f a business (for a minimum of six months) and 1 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:
" rs� Interest" mean
r �
ten
percent(10%)r
ore (including the
ownership r more of the
outstanding
capital
stock)business.
'Business"means any sole propnietorship, sponsorship, corporation, limited liability company,
r other entity or business association.
rid penalties f peou , I d l r t I have read the foregoing document and that the facts
stat ItAare true.
lu
SIS tore
Panted Name
Date