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Laurence HerrupCity of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC(cDmiamibeachfl.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 (J) all that apply): ❑ 1 am a resident of the City of Miami Beach for 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 six months). Name of Business: Laurence A Herrup CPA PA Business Address: 300 71 st Street Ste 620, Miami Beach FL 33141 ❑ I 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 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 of perjury, I declare that I have read the foregoing document and that the facts stated in it ar Signature Laurence A Herrup Printed Name Date