Marcella NovelaCit of Miami Beach
1700- Deva ntionw erste-_ L,,,IV--:,
OFFICE OF THE CITY CALRK
Email:
4F AFFILIATION WITH THE CITY OF MIAMI BEAC
I am in compliancy with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (,/) all that apply):
am a resident of the City of Miami Beach for six months or longer,
� �t )ILA
Home Address: ������ � ��
El I have an ownershipinterest (for a minis um of six months) in a business established in the
City -of Miami Beach (for a minimum of six months)
Name of Business:
Business address:
L1 I am a full -tire employee of a business (for a minimum of six months) and I am based in an
office r other location of the business that is physically located ins Miami mi Beach (for
minimum f six months).
Name of Business:
Business dress:
"Ownership Interest" means the
ownership
of ten percent
(1096) or mare (including the
ownership of 10% or more of the
outstanding
capital stock) in
a business.
"Business" means any sale proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under ies f perjury, I declare that 1 have read the foregoing document and that the facts
stat in it are t e
jP3
Sl*gnatu e Date
a Cr. P 0 V P
Printed Name