Jonathan FrydM IA M I BEACH
City of M iam i Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
DE 28 7323
CITY OF MIAMI BEAOH
OFFICE OF TIE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com p lia nce w ith the aff iliation requirem ent of M iam i Beach C ity C ode Section s 2-22 (4),
as ( check (/) all that ap ply): L3 resid e nt of the C ity of M iam i Beach for six m onths or longer. .-.
H om e A ddr e ss:_ 0o o 26 T
CJ'! have an ow nership interest (for a m inim um of six m onths) in a business established in the
C ity of M ia m i Be ach (for a m inim um of six m onths).
N am e of Busin e ss:_ t0) a-to(u6 UL-_
I
Bu sin e ss A ddre ss:_ 6ht _+-d u) a!
L am a full-tim e em p lo yee of a business (for a m inim um of six m onths) and I am based in an
off ice or other locatio n of the business that is physically located in M iam i Beach (for a
m inim u m of six m onths).
N a m e of Business: __ -----'r,'--J~-1 ..... "'.'\.,_.,,,__..;..tJ_A _£.)_A-''"""~--4----------
u se ss Aaress. 6"1 Woe't« A-86
"O w ne rship Interest" m ean s the ownership of ten percent (10 %) or m ore (including the
ow nership of 10 % or m o re of the outstanding capital stock) in a business.
"B usiness" m eans an y sole proprietorship, sponsorship, corporation, lim ited liability com pany,
or othe r en tity or bu siness association.
U nde r pena ltie s of perju ry , I de clare that I have read the foregoing docum ent and that the facts
stated in ii are ~ ,.,___ / '4, ,Ii,,.
S ig nature D ate I (
A .Aao
Printed N a m e