Robyn MalekCityofof Miami Beach
1740 Convention Center Drive
Miami Bench, Florida 33139
OFFICE OF THE CITY CLERK
Email: BCCcDmia mbeachk Gov
Telephone: 305.673.741 1
AFFIDAVIT OF AFRUATI
i am in compliance with the affiliation r
as (chcic..Lo (V) all that apply):
IV ifflTH THE CITY OF MIAMI BEACH
equirement of Miami Beach City,Code Sect -Ions 2-22 (4),
i am a resident of the City of Miami Beach for six months or Ionger.
Home Address:
0
"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 six months).
Name of Business:
Business Address
am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
Name of Business.-
Business
Address:
"Ownership Interesf means the ownership of ten percent (10%') or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Unde
Sign
r penaines or perjury
finit.-are true.
Printed Name
l declare that I have read the f
oregoing document and that the facts
Date
z�