Allison SlakmanMIAMI BEACH
RECEIVED
MY 0 2024
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.741 l
IT Es.
A«Ml BEACH
Tv+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):
D I am a resident of the City of Miami Beach for six months or longer.
Home Address: -------------------------- □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).
[[q[Pe (of [IS][es.
Business Address: -------------------------
~ 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).
one or sues.. er lass Zc
or» osens Itl /lclpa Ihle_ " Iha al 1/ 33/57
"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 tru~. () ) . J
Lo Jara 0/7/9
Si@nature 7 [n
Khay_S/n po_
Printed Name