Francinelee Hand (2)M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
O FFI C E O F THE C ITY C LERK
Email: BC@miamibeachfl.go
Telephone: 305.673.7411
ECEIVED
4UN 08 2023
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OFFICE OF THE CITY O
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA H
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
[ tam a resident of the City of Mi am i Beach for six months or longer.
Home Aaares:_5313A). Ba4 RA
0 I have an ownership interest (for a minimum of six months) in a business established in the
no City of Miami Beach (for a minimum of six months).
Name of Business: _
Business Address:. _
0 I am a full-time employee of a business (for a minimum of six months) and I am based in an
ho office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
Name of Business:. _
ho 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, I declare that I have read the foregoing document and that the facts
stated~in It are tr , .. , Ee g /as
Signature Date l
-I@k ale -{a l
Printed Name