Alon Alexander •
RECEIVED
MIAMI BEACH MAID 05 2024
City of Miami Beach CH
1700 Convention Center Drive CITY OF t't��`M' RK
Miami Beach, Florida 33139 QFFICE OF THE CINB
OFFICE OF THE CITY CLERK
Email: BC(o�miamibeachtl.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):
I am a resident of the City of Miamii Beach� for six months or longer. (� ('
Home Address: 3 � 5\ b� i"l�Q it� ��� TTV E, M I t I L7(c, 1 ) 35/Lb
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:
nI 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.
/U( )L-4 ) )-(1\
Sign ure Date
(0-, A le)tl(11.
Printed Name