Ambar Herrera GonzalezMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florid 33139
RECEIVED
MAY 28 2024
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7411
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.
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D 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: ------------------------
Business Address: ------------------------
~ 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 or Business: ],a$S fur- ol Dr}
Business Aaaress:. 2lo0 ollio he. air _3cc+,33137
"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
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Signature Date
Boo lecc oonz'2
Printed Name