Amy RabinMIAMI BEACH
RECEIVED
MAR 12 2024
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA CH
I am in co mpliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (ch eck (/) all that apply):
~I am a resident of the City of Miami Beach for six months or longer. or.... 33)1).28g1, MN~ [ah ? 331o
J 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
office or other loca tion of the business that is physica lly 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.
Signr,l~
Printed Name
Date