Carmen DatorreMIAMI 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
JUL 2 9 2024
CITY OF MIAMI BEACHOFFICFOTIECITYCLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in ompliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (cl ck (/)all that apply):
I am a resident of the City of Miami Beach for six months or longer.»a...76"gr Ge«r3/90
~ave 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 ot uses._/@u°>ha"3_
Business Address:
[D]1am a full-time employee of a business (for a minimum of six months)and l 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:'j.,fVl.,u,-n·OVl,,I..~
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.
ies of perju
Printed Name
eclare that I have read the foregoing document and that the facts
DateT 1