Laurence Moser RECEIVED
MIAMI BEACH MAR :11:24
FF?C O1C!•irEACH
City of Miami Beach OF TH
1700 Convention Center Drive CLERK
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email. BCamiamibeaChfl qov
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):
1 I am a resident of the City of Miami Beach for six months or longer.
Home Address:4767 Alton Road Miami Beach, FL 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:Gateways Unlimited, Inc.
Business Address:4767 Alton Road Miami Beach, FL 33140
1 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:Gateways Unlimited, Inc.
Business Address 4767 Alton Road Miami Beach, FL 33140
"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
stat4s,..v\io1/4,are true.
1(p `-1 3/4/24
Signature Date
Laurence Moser
Printed Name