Seth Gadinskyatf of Mi4m I @each
1700 Cor*mficn Carder Drive
Mlaml Bond, T-bida 33139
OFFICE Of THE CITY CLERK
Frnaif- 13CAmigrgibgs
- - wbLwa
Telephww 3D,57.6 -73.7A I I
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I arri in c.-wpltanco with the affiliation requiremeRt of Miami Rwh City Code Sections 2-22 (4).
as (chem (,/) adl that apply):
P1 I am a re5iderit of the City of Miami Beach for six moths or longer.
Home Address- 3530 Pine Tree D r
El I have an awrPer5hip interest -(tr a rninlmurn of six rnDnths) In a business established in the
C4 of Miami lawob (fora rnlnkmkjrn of Glx months) -
Name of Busarkess:
Business Address -
i am a full-time employee of a busines=s (for a m1airnum of six months) and I am based in an
office or other tDcation of the business that is "ically twated in Miami Beach {for a
miriimum of six months).
Name of Business:
Business Address;
`Ownership InforesfN rooans the owoorshio of ton Porcent (10%) or r (jncwif�g the
ownership of I&% or ffwo Df the oeitstanding capfad stock) in a busnoss.
4Susinoss'rrwarrs any sde prWatcwship, spons�vship, carpcv-atian, �imftod fiabiw cumpany,
or other enfity or business as-sociatian.
Under penalties of pwjuror, I dedaro thiat I have read the for inn document anti 111at the facts
stated in Ware true.
6/20/23
Printed Nane