Janis Good� .
P-'
` �V I B.
1i`" %' ofMann' Bauch
1700 Convention Center 0FIVe
Mani'
Beodi, Florida 13 1,19
OFFICE OF TH[.' ("111" �.a[LYKEmail" BCIf I
FFIAVIT
FFILIATIgN WITH THE
am in compliance with the caffilia tion r
as (check (v) all that apply).
ITY OF MIAMI BEACH
eqUirement of Miami B+� rh City Code l o 2.22(4),
9f I am a resident of the City of Miami Beac • for six months or longer.
Home address:
L;
C4
El I have an ownership interest (for a minimum of six months
City of Miami Beach (for a minimum of six months).
Name of.
Business Address:
it 0
it P" / z ec#Ae eo,
} in a bu0%
siness established in the
El 1 arra a fullwfime employee of a business {for a minimum of six months) and 1 am based in an
office or other location of the business that i
minimum of six months).
Name of Business:
Business Address:
s physically located
in Miami Beach
(for a
"Ownership Interest" mans the ownership of ten percent (1O%,") or more (including the
ownership of ?Q% or more of the autstanrlinq capital stocky in a business,
"'Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perjury, i
stated in it are true,,
declare that I have read the foregoing document and that the facts
FAP�..,.Rno
Sj@rtTa ffre
Ja h; s F. Goo�P
Printed Name
date