Julio MagrissoM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf].goy
Telephone: 305.673.7 411
RECEIVED
JAN 09 2024
CI TY OF M IAMI BEACH
OFFICE OE TUE c/Ty c!En
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am jn compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
eck (/) all that apply):
am a resident of the City of Miami Beach for six months or longer.
torn- woes. _1'70 SL2//Dy /ha tel _
D 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: ----------------------- □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 .. · _
"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.
enalties of p
it are true.
, I declare that I have read the foregoing document and that the facts
/lo
Date
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