Danielle Klahr MIAMI BEACH FE B 0 5 2024
City of Miami Beach
1700 Convention Center Drive CITY pF MIAMI gE,yC RECEIVED
Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC a(�miamibeachflmov
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):
0 I am a resident of the City of Miami Beach for six months or longer.
Home Address:
0 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:
B siness 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).
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Name of Business: V.-611\ — -1=3-,1 ,- R (7„,,
Business Address: / U \c 1
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"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 true.
Signature Date
� 01/VCUR— 'Cie, Lr
Printed Name