Jack Glottmann M I AM I BEACH RECEIVED
City of Miami Beach MAR HE 05 2024CITY
1 700 Convention Center Drive CITY OF P, IaMI B Miami Beach, Honda 33139 OFFICE OFT EACH
CLERK
OFFICE OF THE CITY CLERK
Email: BC(a�miamibeachfl.gov
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 (✓) all that apply):
I am a resident of the City of Miami Beach for six months or longer.
Home Address:560 Lakeview Drive, Miami Beach, Florida 33140
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
statetriih
—:— . � March 3, 2024
Signature Date
Jack Glottmann
Printed Name