Lymari VelozM IAM I BEA CH
City of Miami Beach
1 700 C onvention C enter Drive
M iam i Beach, Florida 33 13 9
RECEIVED
JAN 0 9 2024
CITY OF MIAMI BEACH
OFFICE OF THE CIT CL ER K
O FFIC E O F TH E C ITY C LERK
Email: BC@miamibeachfl. gov
Telephone: 305.6 7 3.7 4 11
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):
ti] I am a resident of the City of Miami Beach for six months or longer.
«
rome Aaoress. [66} g@' Aye »3of a,,
01 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 or Business. l e«cl Hae )a/on ---'~-----------';;c..._'----'------------
Business Address: 103 HI+o k w 4 ,
D I am 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: -------------------------
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 of perjury, I declare that I have read the foregoing document and that the facts
stat e d in it are true. ,n) // $={s. .//y sowvme, 1/, one' T 7
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Printed Name