Damian GalloRECE IVED
MAR 22 2024
City of Miami Beach
1700 Convention Center Drive
M iam i Beach, Florida 33139
CIT OF "AMI BEACH
Err CI TY CLER
OFFICE OF THE CITY CLERK
Email: BC@ miamibeachfl.gov
Telephone: 305.673.7 411
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):
D I am a resident of the City of Miami Beach for six months or longer.
Home Address: ---------------------------
[/EI 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: DAMIAN J. GALLO & ASSOCIATES, INC.
Business Address: 775 17 STREET MIAMI BEACH FL 33139
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 entity or business association.
Unde penalt 1 \ of perjury, I declare that I have read the foregoing document and that the facts
state in it ar rue.
03/22/2024
Date
J. GALLO