Steven AdkinsI
I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Flor ida 33139
REO"
FEB @
CITY O
OFFICE ?
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIANII BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
Home Address: -------------------------- □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:
loo
Business Address: -------------------------
/} 1 am a full-time employee of a business (for a minimum of six months) and l am based in an
office or other location of the business that is physically located in Miami Beach (for a
m inim um of six m onth s).
Name of Business. Greater Miami LGBTQ Chamber of C om m er c e
Business Address: 1130 Washington Ave - 1st Floor North, Miami Beach, FL 33139
"Ownership Interest" means the own ership 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 ot h er entity or busin ess association .
Under pen~alties of p.erjury.i. I declare that I have read the foregoing document and that the facts
stated in iL, • »
., Janu ar y 12, 2024
Signature ' Date
Steven Adkins
Printed Name