Bradley Golden11A i
RE C EIVE D
JUL -6 2023
OF MIAMI BEAOH go iier@ii
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@m i amibe achfl.gov
Telep hon e: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com p lia nce wi th th e affil iation requirem ent of Miam i Beach Ci ty Code Sections 2-22 (4),
as (ch e :/) all th at ap pl y):
l am a resident of th e C ity of Mi a m i Beach for six month s or long er.
H om e Address: -------------------------- [ Et have an ownersh ip inter e st ((or a mi nim um of six m onth s) in a busi ness est ablishe d in th e
Ci ty of Mi a m i Beach (for a mi nimum of six m on th s).
N ame of Busin ess: -------------------------
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[{1am a full-time employee of a business (for a mi n im um of six month s) and l am based in an
offi ce or other location of the business tha t is phy sically locat ed in Miami Beach (for a
minimum of six month s).
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"Ownership Interest" means the ownership of ten percent (10%) or m ore (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 ot he r enfity or busin ess associat ion .
Under peA. a'1/~✓.npeerrjury, I declare that I have read the fore going do cum. en! and that the facts iis5jfi «G" 7//2•9
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