Zaymar VargasMIAMI
City of Miami Beach
1700 Con vention Center Drive
Mi am i Be a ch , Flor ida 3 3139
RECEIVED
JUL 10 2023
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
CIT OF MIAMI BEACH
OFFICE OE E 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):
rJr" I am a resident of the City of Miami Beach for six months or longer.
ens.woo..7I3S bolt eg, pl6r tr.bah1±an
D 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: -------------------------
Business Address: _
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 'X"! tl have read the foregoing document and that the facts
stated in i
01/,/as23
Date /
Printed Name