Dany RaffoulM IA M I BEACH
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
AUG 25 2023
CITY OF MIAMI BE ornir or ii~ en22%;;
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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 (ch eck (/) all that apply):
[/[1 a m a resident of the City of Miam i Beach for six mon ths or long er.
1800 Purdy Avenue #2207 Miami Beach FL 33139 bl(mp J]][,},
D I have an ownership interest (for a minimum of six months) in a business established in the
C ity of Miami Beach (for a minimum of six months).
N a m e o f Business: _
B usin e ss A d d re ss: _
D I am a full-tim e em p lo ye e of a busin e ss (fo r a m in im u m o f six m o nths) and I a m b a se d in an
offi ce or othe r lo ca tio n of the busin e ss tha t is physica lly lo cated in M ia m i B e a ch (for a
m in im u m o f six m o nths).
N a m e o f B us in e ss: --------------------------
B u sin e ss A d d re ss: --------------------------
"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.
U n d e r pe n a ltie s o f p e rju ry , I cl a re tha t I h a ve re a d the fo reg o in g do cum e nt an d th at the facts
sta te d in it are true
2. A 08.25.23
S ig n a tu re
Dany Raffoul
D ate
P rin te d N a m e