Steven HaasM IA M I B EA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JUN 13 2023
C ITY O F M IA M I BEA C H
OFFICE OF TH E CITY CL ER K
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
A FFIDA V IT O F A FFILI A TIO N W IT H THE CITY O F M IAM I BEA C H
I am in co m p lia n c e w ith the aff iliatio n re q u ire m ent of M ia m i B each C ity C ode Se ctio ns 2-22 (4),
as (ch e ck (/) all tha t ap p ly):
D I a m a re s id ent of th e City of Miami Bea ch fo r six m o nths or lo ng er.
H o m e A d dre ss : --------------------------
D I ha v e a n ow nersh ip in te re st (fo r a m in im um of six m onths) in a busine ss estab lished in the
C ity of M ia m i B e a ch (fo r a m in im u m of six m onths).
N a m e of B u sin e ss : -------------------------
Business Address: _
'~) I am a fu ll-tim e e m plo yee of a business (fo r a m in im um of six m onths) and I am based in an
I off ic e or other lo ca tio n of the busin ess th at is physically lo cated in M ia m i Be ach (fo r a
m in im u m of six m onths).
Nam e ot Business. 1(/ ild,
u sm e ss A d dr e ss._[{ @ Le@9/alma ya«4 9)@t·
"O wnership Interest" m eans the ownership of ten percent (10%) or m ore (including the
ow nership of 10% or m ore of the outstanding capital stock) in a business.
"Business" m eans any sole pro prietorship, sponsorship, corporation, lim ited liability com pany,
or other entity or business association.
na ltie s of perju ry, I de cla re th a t I ha ve rea d the fo rego ing do cum ent and that the facts
it are true .
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