Carolina CuadrosMIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@m iam ibeachf.gov
Telephone : 30 5 .6 7 3.7 4 11
AFFID AVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com pliance w ith the affi liation requirem ent of M iam i B each C ity Code Sections 2-22 (4),
as (check(✓) all that apply):
~ I am a resident of the City of Miami Beach for six months or longer.
Home Address. goo ollio _ll_cl iar· 0eccl + 33140
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: -------------------------
D 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 are true.
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Signature Date
Carolina Coad~oo
Printed Name