Mayra Diaz ButtacavoliBE H
City of Miami Beach
1700 Convention Center Drive
M i a mi Beach , Flo rid a 3 313 9
OFFICE OF THE CITY CIERK
Email BC@miamibeachf.gov
Telephone: 305.673.7411
RECEIVE D
JUL -5 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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):
h] 4am a resident of the City of Miami Beach for six months or longer.
Hom e Addres .,._e,,: -=y;'-·-~----1-+ _
[4have an own ersh ip intere st (for a minimum of six m onth s) in a busine ss established in th e
City of Miami Beach (for a m inim um of six m onth s).
Name of Busin ess: --------------------------
Business Address: too
[ \1am 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).
par f }11 ]f S S ,
P[JS,]f@, L ]Hf@ ,,
"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, limi ted 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.
a.#den, St«ca«ad-
Mayra Diaz Buttacavoli
7/1/2023
Date
Printed Name
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