Jeevan TillitM IA M I BEACH
City of M iam i Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
MAR 212024
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OFFICE OF THE CITY CLERK
E m a il: B C @ m ia m ibe achfl.gov
Telephone: 305.673.741 l
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA CH
I am in com p liance w ith the aff iliatio n req uirem e nt of M iam i Beach C ity C ode Sections 2-22 (4),
as (che ck (✓) all that apply):
D I am a resid e nt of the C ity of M iam i B each for six m onths or longer.
H o m e A dd ress: --------------------------- □I ha ve an ow ne rship interest (fo r a m inim um of six m onths) in a business established in the
C ity of M ia m i B e a ch (fo r a m inim um of six m onths).
N a m e of B usin e ss: --------------------------
Bus in e ss A dd ress: -------------------------- □I am a full-tim e em p lo yee of a business (fo r a m inim um of six m onths) and I am based in an
off ice or othe r lo catio n of the business that is physically located in M iam i Beach (fo r a
m in im u m of six m o nths).
N a m e of B usine ss: --------------------------
Bus in e ss A dd ress: --------------------------
"O w ne rship Interest" m eans the ownership of ten percent (10%) or m ore (including the
ow ne rship of 10% or m o re of the outstanding cap ital stock) in a business.
"B u sine ss" m ea ns any sole pro prietorship, sp onsorship, corporation, lim ited liability com pany,
or othe r en tity or bu siness association.
U n d e r pe naltie s of pe rjury , I de clare that I have read the fo regoing docum ent and that the facts
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