Christine KlingsporM IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emai l: BC@miamibeachfl,gov
Telephone: 305.673.7411
CENVED
1AR 03207
A4 BEACH cm_Of,"r
OFFICE O' "
AFFIDAVIT OF AFFILIATION ITH THE CIIy 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):
~ a resident of the City of Miami Beach for six months or longer.
Home Aaddress: 'oo JEfco.fl ±Loo _a.led,,E 1 D 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: _
D I am a full-time employee of a business (for a minimum of six months) and I am based in an
offi ce 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.
si@naiare J
Ctr-1STU E AU ,2Pa £.
Printed Name
Date 1