Peter A Matos RECEIVED
MAMI BEACH FEB 0 8 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(Wmiamibeachfl.gov
Telephone:305.673.7411
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(J) all that apply):
v' I am a resident of the City of Miami Beach for six months or longer.
Home Address:1465 Cleveland Rd, Miami Beach FL 33141
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 tryer-
2/8/24
Signature Date
Peter Matos
Printed Name