Laura Lewin (2)M IA M I BEACH RECEIVED t..» ! .I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
MAR 18 024
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7411
CITY OF ii\AMI BEACH
OF F!C E OF TH E CI TY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in co m p liance w ith the affil ia tion requirem ent of M iam i Beach C ity C ode Section s 2-22 (4),
as (che ck (✓) all tha t apply):
lE 1 a m a resi d en t of th e Ci ty of Miami Beach for six m on th s or lon ger.
H o m e A ddre ss.6 5 0 W est Ave. Apt. 17 0 9, Mi ami Beach, FL 33 13 9
D I ha ve an ow nership inte rest (fo r a m inim um of six m onths) in a business established in the
C ity of M ia m i Be a ch (fo r a m in im um of six m onths).
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D I am a full-tim e em p loyee of a business (fo r a m inim um of six m onths) and I am based in an
offi ce or othe r location of the business that is physically located in M iam i B each (fo r a
m inim um of six m o nths).
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"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" m ea n s any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
altie s of pe rjury , I de cla re that I have read the fo regoing docum ent and that the facts
ta re true.
March 18, 2024
D ate
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