Julian LinaresM IA M I BEACH
C ity o f M ia m i B e a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVEt
JAN 22,-
CITY OF MIAMI BEACH
OFFICE OF T HE CITY CLERK
OFFICE OF THE CITY CLERK
Em a il: BC @ m ia m ib e a chfl.g o v
Telephone: 305.673.7411
A FFIDA VIT O F A FFILIATIO N W IT H THE CIT Y O F M IA M I BEA CH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
0 I am a resident of the City of Miami Beach for six months or longer.
ome A«ores:_66 00 Colli Ae ht lli@4t_Beak_ f4 331/0
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.
Under pen alties of perjur r, :lare that I have read the foregoing documen t and that the facts
stated in it are true.
Signature
lLu'
Printed Name
/Ag2oY
bate