Christopher Rollins RECEIVED
MIAMI BEACH FEB 20 2024
City of Miami Beach CITY f MIAMI BEACH
1700 Convention Center Drive OFFICE OF THE CITY CLERK
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:BC(&niamibeachfl.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(✓)all that apply):
l l I am a resident of the City of Miami Beach for six months or longer.
Home Address:
ElI 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:
X 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: If ivelli ; /, L
Business Address: JjJQQ rfk ' L,P, [ /)1j y'j JJ14cf(, g 35,37
"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
staiedyin it are tru//e.
4 R216444") cfe-1— At -211-4(
ignature Date
Printed Name