Tiffany HecklerMIAM|IBEACH
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
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
|am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
es that apply):
|am a resident of the City of Miami Beach for six months or longer.
O
Home Address:LCoS:N.Bh 1 RD Mia BCACH FE SA¥0
!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).
Name of Business:
Business Address:
|am a full-time employee of a business (for a minimum of six months)and |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:
?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.
Under penalties of perjury,|declare that |have read the foregoing document and that the facts
stated in it are true.
(|{2023
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