David NguahM IA M I B EA C H
City o f Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JAN 18 2024
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OFFICE OF THE CITY CLERK
Email: BC@m iamibeachfl.gov
Telephone: 305.673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com pliance with the affiliation requirem ent of M iam i Beach C ity Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
I✓I I am a resident of the City of M iam i Beach fo r six m onths or longer.
Hom e A ddress: 1308 D rexel Ave # 207, M iam i Beach FL 33139
D I have an ow nership interest (fo r a minim um of six months) in a business established in the
City of M iam i Beach (fo r a m inim um of six m onths).
[[ar e (f [[Jg]neSS,
y ]fess (]]res8S,
[Z] am a full-tim e em ployee of a business (fo r a minim um of six months) and I am based in an
office or other location of the business that is physically located in M iam i Beach (fo r a
m inim um of six months).
Nam e of Business: D ouglas Ellim an - R eal Estate Agent
B usiness Addre ss: 1111 Li ncoln R oad# 805, M iam i Beach FL 33139
"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 fo regoing docum ent and that the facts
stated in it are true.
cog 100
S ignature Date
David Nguah
P rinted Nam e