Moshe RothmanCity of ARiami Beach
1700 Convention Center Drive
Miami Beach, Florid-- a 33139
OFFICE OF THE CITY CLERK
Email: BC
Telephone
3-05.6,73..'7A
11090V
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AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
E am in compliance w
as (check (J) all that
ith the aff10
iliati
apply):
on requirement of Miami Beach City Code Sections 2-22 (4),
am a resident of the City of Miami Beachfor six months or longer..
Home Address:
I have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of sixtmonths).
Name of Business
-
am A
a IN
re r =4 ft LV, Inj
,I am a full-time- employee of a business
office or other location of the business that is physically located
for a minimum of six months), and Ir am based in an
in
minimum of six months).
Mia i Beach
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Signature
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