Jack BenvenisteM IA M I BEAC H
City of Miami Beach
17 00 C on ven tion Center Drive
Miami Beach, Florida 33 13 9
OFFICE OF THE CITY CLERK
Email: BC@mi amibeachf. gov
Tele phon e : 30 5.6 7 3.7 4 11
RECE IVED
JAN 18 2024
CITY OF MIAMI BEACH
OFFICE OF T HE CITY CL ER
A FFID A V IT O F A FF ILIA T IO N W ITH T H E C IT Y O F M IA M I B E A C H
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (ch eck (/) all that apply):
W I am a resident of the City of Miami Beach for six months or longer.
Home Address. 80l5 Noremac Avenue"Iami Beach, Fl 33141
]1have an ownership interest (for a minimum of six months) in a business estab lish e d in the
City of Miami Beach (for a minimum of six months).
Name of Business. dun bpoE
Business Address !Olk- 7l >to M1am1Beach» Tl 22ll
E[lam 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).
[[a[Te f by,/meSi,
P[Ines (]Sf@SS,
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outs tanding 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 a e true.
01/18/2024
Date
Jack Benveniste
Printed Name