Betty BeharM IA M IB E H
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 29 2023
CITY OF MIAMI BEA CH
OFFI CE Or -IE CITY CL ER K
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):
~a resident of the City of Miami Beach for six months or longer.
• AG.o> pd= Ade \; Eg.
0 I have an ownership interest (for a minimum of six months) in a business established in the 5 L/c)
City of Miami Beach (for a minimum of six months).
or «an. _"ex@4 or)
so» woos f5(G i\pi\- as
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).
[Jame [y[[eSS,
[JS[[es,S [\(][feSS,
"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.
I Under pe
state
Sig
I
I declare that I have read the foregoing document and that the facts
elk
Becka4 Date
Printed Name