Claudia Sedighim··H> .. ·. ±
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City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JUN 3 2074
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 (s/) all that apply):
L am a resident of the City of Miami Beach for six months or longer . .
Home Address:. 74 -aqoY co_Dr. A(a [Seal.Kc 3Sigo
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: ------------------------- □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.
gda. sad' Signature .
Claudia 5e d ,l ,r
Date
Printed Name