Susan Mirielle Enlow (2)I
/V\IAMIBEACH
City of Miami Beach
1700 Con vention C en ter Drive
Mi am i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeach1fl_goy
Telephone: 305.673.7411
RECEIVED
Jut 10 2023
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2!T,Y OF MIAMI BEACH
FFICE Or7H E CITY CL~RN ,,,
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
'ftJ I am a resident of the City of Miami Beach for six months or longer.
[] Ihave an ownership interest (for a minimum of six months) in a business established in the
City of Mi am i Beach (for a minimum of six months).
#
99%..
fame of Business.
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· ~ 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: Li 5M
t
lac ualttasot
loo Med., 303
1, 33135
"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" m eans any sole proprietorship, sponsorship, corporation, limited liability comp any,
or other entity or business association. >
Business Address:
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated i it are true.
lo Date
Printed Name