Gabriel J. Paez RECEIVED
MAM BEACH FEB 20 2024
C"N�;' ; i31 BEACH
City of Miami Beach '.ARK
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BCna miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in co iance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (c k (J) all that apply):
I am a resident of the City of Miami Beach for six months or longer. tt
Home Address: IQC I_.tr1CALr1R-z +(b3g f�,ioJM4 eacL ( RA 33139
nI 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:
riI 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.
Un•- •en. .-s of perjury, I declare that I have read the foregoing document and that the facts
ated in it ar- trA / \
4ri�r1 2- . L • �-2i
Si.nat —'-� Date
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Printed Name