Michael KielyM IA M I B E A C H
City o f M iam i Be a ch
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
4AR 06 204
BE A CH CY OF M'
6£C E O F THE C ITY
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA CH
I am in com plia nce w ith the affi liation requirem ent of M iam i Beach C ity Code Section s 2-22 (4),
as (ch eck (/) all that ap ply):
[/[1am a resid ent of th e City of Miami Beach for si x m onth s or lon ger.
H o m e A dd ress: 65 0 W est A ve, #27 12 Miami B each FL 33 13 9
[/[ I ha ve an own e rsh ip int ere st (for a mi n im um of six m onth s) in a busin ess est ablish e d in th e
C ity of M ia m i Be a ch (fo r a m inim um of six m onths).
N a m e of Business: C o nn e cte d S outh Flo rida LLC
Busine ss A ddress: 65 0 W e st A ve # 27 12 M ia m i B e a ch FL 3313 9
D I am a full-tim e em plo yee of a business (for a m inim um of six m onths) and I am based in an
offi ce or other loca tion of the business that is physically located in M iam i Beach (fo r a
m in im um of six m onths).
D a mn (f H y [feSS,
H3 ySIne s (d d feSS,
"O w nership Interest" m ean s the ow nership of ten percent (10%) or m ore (including the
ow nership of 10 % or m ore of the outstanding cap ital stock) in a business.
B usiness" m e ans any sole proprietorship, sponsorship, corporation, lim ited liability com pany,
or other en tity or bu sine ss association.
U nd e r pe na ltie s of perjury , I de cl a re that I have read the fo regoing docum ent and that the facts
stated in it are true.
Mikael Kiely M a rch 1, 20 24
S ig nature
M ic h a e l K ie ly
D ate
Printed N am e