Alejandro BelloMIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JUN 27 2023 g,,,9E, At EAc
FICE OF THE CITY CLERk
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
Home Address: ---------------------------
D 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: --------------------------
[ 1an a fol-ime employee or a{ks (tor a minimum of six months) and l 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 Interest" 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.
Under penalties ~;.1jury, I declare that I have read the foregoing document and that the facts 22 ,
Sign ture Date 7 7
Al@c-po ello
Printed Name