Heriberto SosaMI AMI BE C
City of Miami Beach
l 700 Convention Center Drive
M iam i Beach, Florida 33139
RECEIVED
JAN 18 2024
CITY OF MIAMI BEACH
OFFICE Or THE CITY CLERK
OFFICE OF THE CITY CLERK
Em ail: BC @m i am i be achfl.g ov
Telephone: 305.673.7 411
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):
I ] am a resident of the City of Miami Beach for six months or longer.
Home Address: 831 9th Street, Miami Beach, Fl
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: _
D 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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
Herb Sosa . 1/17/2024
Signature
Herb Sosa
Date
Printed Name