Troy WrightM IA M I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAY 19 2023
CITY OF MIAMI BEACH
OF FI CE OF THE CITY CLER
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City 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.
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□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).
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x~ lam a full-time employee of a business (for 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).
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Business Address 21o \}it$/Of0n /.
"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 associatio . ·
Under-pepalli es o9
are true. )
at I have read the foregoing document nd that th facts stated in it s 23
Signature.
Le Printed Name
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of u physic al presence o/u on line notarization,
o» 11aero ri a2 ». llf
(City of Miami Beach Board/Committee Member).
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Name of Notary, Typed, Printed, or Stamped