Haley RossMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@mamibeachfl_gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
As a voting member of the Committee for Quality Education in Miami Beach, I am in
compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4) and
2-190.137 as.
D I am a City of Miami Beach resident for six months or longer.
Home Address: --------------------------
D I am the parent/guardian of a student attending a Miami Beach school for the school
year.
School: -----------------------------
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
Signature Date
Printed Name