Steven Adkins (2)MIAMI(BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
NY 30 207
CIT OF MIAMI BEAGl
FFICE OF THE CITY CLER'
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.go¥
Telephone: 305.673.741l
AFFID Tr QF AFFILIT1 oN yIT THE cry oF_A1AMAL BEA CH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (+)
as (check (/) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
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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).
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l1am 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: MDGL CC ·-------------------------
8
. Add 1130 Washington Ave. 1st Floor North, Miami Beach, FL 33139
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"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.
~n~~ I declare that I have read the foregoing document and that the facts
",7%E stat ignature Date '
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Printed Name 7