Karen Edelstein •
MIAMI BEACH RECEIVED
City of Miami Beach FEB 2 8 2024
1700 Convention Center Drive
Miami Beach, Florida 33139 FFN of MIAN]i
OFFICE OF THE CITY CLERK CE OF THE CITY CACH
Email BC@miamibeachfl qov
ERK
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(I) all that apply):
I am a resident of the City of Miami Beach for six months or longer.
Home Address: 7L 6t y% .Sht'r/ T
l l 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 true.
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Signature Date
Kcl of n ECi P l S401
Printed Name
1111