Michel Tessier (2)MIAMI BEACH
City oF Miami Beach
1700 Convention Center Drive
Mlorni Beach, Florida 33139
OFFICE Of THE CITY CLERK
Ema�: UCAmiarnibeac".grnr
Telephone: 305 673 7A1 1
AFFIDAVIT OF AFFILIATION Vhl TH THE QjTY._QFF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2- 2 (4),
as (check (,/) all that apply):
XrI am a resident of the City of iti+'liami Bead for six months or longer.
Home Address) <��.n Q0 I 'l M Z$ ~OWUii I ��
Cl I have an ownership interest (for a minirmurn of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
Name of Business.
Business Address:
L7 I am 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 lacated in Miami Beach (for a
minimum of six months) -
Name of Business:
Business Address:
"Ownership lnteresl' means the ownership of ter+ pent f ?0%) or more (incluMng the
ownership of 10% or more of the outstanding capital stock} in a business.
"Susiness" means any sale propfieforship, sponsorship, corporation, !united liability company,
or other entity or business association -
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in! ar tru .
nature Date
Printed dame