Pam Rogers MIAMI BEACH RECEIVED
City of Miami Beach MAR 05 2024
1700 Convention Center Drive
Miami Beach, Florida 33139 COFFICE! oF1'r�fAM�BEAC
OFFICE OF THE CITY CLERK THE Clay CLE K
Email: BCAmiamibeachfl.Aov
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 (I) all that apply):
✓❑ I am a resident of the City of Miami Beach for six months or longer.
Home Address:5415 Collins Ave, #505, 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:
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.
/Pam Rogers/ 3/4/24
Signature Date
Pam Rogers
Printed Name