Louise de PodestaCity A
Board
MIAMI BEACH
City o f M ia m i B ea ch
17 0 0 C onvention C enter D rive
M ia m i Beach, Florido 33 139
RECEIVED
JUN 01 2023
CITY OF MIAMI BEACH
O FFICE OF TH E C ITY CLERK
MK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfI.gov
Telephone: 305.6 73.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI 13
I am in compliance with the affiliation requirement of Miami Beach City Co
as (check (/) all that apply):
✓i am a resident of the City of Miami Beach for six months or longer.
Home Address. 5kl6 Que %l l w cw lec.ch
FR 33t34 D I have an ownership interest (for a minimum of six months) in a busin
City of Miami Beach (for a minimum of six months).
Jame [ [ysjneSS.__-------------------------------------
[3ysjess \ddreSsS'__---------------------------------------
D I am a full-time employee of a business (for a minimum of six months)
office or other location of the business that is physically located in
minimum of six months).
[are of [yS[feSS.__---------------------------------------
[3yS]Ress ddf@SS._---------------------------------------
"Ownership Interest" means the ownership of ten percent (7 0%) or
ownership of 10% or more of the outstanding capital stock) in a busines
"Business" means any sole proprietorship, sponsorship, corporation, fim
or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing docum
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Signature Date
ooc eel D a a
Printed Name