Curtis W. Slipman, MD RECEIVED
MIAMI BEACH FEB O 5 2024
CITY OF MIAMI BEACH
City of Miami Beach OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:BC(an7miamibeachfl.c ov
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):
✓ I am a resident of the City of Miami Beach for six months or longer.
Home Address: 1455 OCEAN DRIVE, #710, Miami Beach, El 33139
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 e ity or business association.
•er :-n: -. of perjury, I declare that I have read the foregoing document and that the facts
stated in ' - rue.
1
2.05.2024
Sig Afure Date
C y s Sli• an
'tinted Name