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Orlando Jacinto Gracia RECEIVED MIAM BEACH FEB 062024 City of Miami Beach CITY OF MIAMI BEACH Miam170m Convention i Beach, Florida nter 33139 Drive OFFICE 7r 7 aF CIIT 'CLERK OFFICE OF THE CITY CLERK Email: BC©miamibeachfl.gov Telephone: 305.673.741 1 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): 1 I am a resident of the City of Miami Beach for six months or longer. Home Address:2455 Flamingo Drive #404, Miami Beach, FL 33140 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 penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are t ue. February 5, 2024 Signature Date Orlando Jacinto Garcia Printed Name