Jacquelynn PowersM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JUN 13 2023
CITY OF MIAM I BEACH
OFF IC E O F TH E C ITY CLERK
OFFICE OF THE CITY CLERK
Em ail: B C @m i am i be ach fl.gov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
As a voting member of the Committee for Quality Education in Miami Beach, I am in compliance
with the affiliation requirement of Miami Beach City Code Sections 2-22 (4) and 2-190.137 as,
(check (/) all that apply):
~ I am a City of Miami Beach resident for six months or longer.
ore A«aress. """""""""""a""
IXl I am the parent/guardian of a student attending a Miami Beach school for the 2023-24 school
year.
The Innovative School at Temple Beth Sholom School: _
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
(}.f\---- __ 6_11_31_20_2_3 _
Signature Date
Jacquelynn Powers
Printed Name