Martin ZaiacMI/AM,BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfL.gov
Telephone: 305.673.7411
H
RE CE IVED
MAY 30 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in co m plian ce with th e affi liation requirem en t of M iami B each City C ode Section s 2-22 (4),
as (ch e ck (/) all that ap pl y):
[] lam a re sid en t of th e City of Miami Beach for six months or long er .
pt)Pr% l\rt](ff9Si,o»
[] 1h a ve an own ershi p int ere st (for a m inim um of six m on th s) in a busi ness establish ed in th e
City of Miam i B each (for a minimum of six months).
[pm (f [[11 f9,S,
Busie$6 A ddr e ss:
[fa a full-time employee of a business (for a minimum of six months) and I am based in an
offi ce or other locat ion of the business th at is physically located in M iami Beach (for a
momom ots mon) /~ [7, /
voe or sues @ v. l, _./ 9a
e s oo. f3$ ,_,l J. re {I3ijo
"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" m .. ef3an .. ··s a~n1y c::£-. proprietorship, sponsorship, corporation, limited liability company,
or other entity or b us~64 association.
/
U n d er penalties of perj z, I decl are tha t I have read th e fore goi ng docum en t an d that th e fact s s6
a f# on»
Print e d N