Sabrina CohenEmail: BC@miamibeachfl.gov
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 (ض) all that apply):
Ƒ I am a resident of the City of Miami Beach for six months or longer.
Home Address:___________________________________________________________
Ƒ 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:_________________________________________________________
Ƒ 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:_________________________________________________________
³2ZQHUVKLS ,QWHUHVW´ means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
³%XVLQHVV´PHDQs 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 in it are true.
Signature Date
Printed Name