Clare McCord (2)MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7411
RECEIVED
JUN 3 0 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
A FFID A V IT O F A FFILI A T IO N W IT H THE C IT Y 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):
~ I am a resident of the City of Miami Beach for six months or longer.
Home Address: 800 West Ave, Unit 629, MB, FL 33139
~ 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: McCord Consulting Inc
Business Address: 1521 Alton Rd, Suite 232, MB FL 33139
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" it,are tr
C 6/29/23
Date
Printed Name