William RoedyM IA M I B E AC H
City of Miami Beach
17 0 0 C o nventio n C e nter D rive
M iami Beach , Flor ida 33 13 9
RECEIVED
MAR 08 224
%2.9.±29.
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 30 5.6 7 3 .7 4 11
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):
[1am a resident of the City of Miami Beach for six months or longer.
Home Address: 1455 Ocean Drive, Unit 1005 Miami Beach, FL 33139
D 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
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
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William Roedy
Printed Name