Darren CefaluM IA M I BEA C H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
R ECE I VED
APR 10 2024
CITY OF MIAM I BEACH
OFFICE OF THE IT C!ERK
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):
Warn a resident of the City of Miami Beach for six months or longer.
Hore Adress: _3 el &Av<_ Io]
[2sl 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:_R-.~--•~~~~~k-""'~VV\.~-]_~_tC~O~v_€_0_,__-G~o~~ ""~V'.._$~-e..._/,_!J_
sou s e s A war e ss 65o il" shh of
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
stated in it are true.
Date / I '
Darren Cefalu
Printed Name