Iryna CorriganCity of Miami Beach
700 Convention Centor Drive
Miami Beach, Florida 33139
RECEIVED
JUL 03 2024
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email. C@miamibeachfl. gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply).
[/]1am a resident of the City of Miami Beach for six months or longer.
}i s g, 6 Sis, ,9, go9
Home Address: -------------~------------------------
[/[4have an ownership interest (for a minimum of six months) in a business establi
City of Miami Beach (for a minimum of six months).
are or sees, _G(o&a@_9coy fa..£co_ (@__
Business Address. Y50 4__8pt 6D4,Mani eo chf33/39
l am a full-time employee of a business (for a minimum of six months) and 1 am based mn an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months). is
ors osure»»6Gaff "5e Pt«hr
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"Ownership Interest" means the ownership of ten percent (10%) or more (including
ownership of 10% or more of the outstanding capital stock) in a business. an%$
"Business" means any sole proprietorship, sponsorship, corporation,
or other entity or business association. pee #
' . .. . ' .
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true. ii@tee ea___ _@if lo4you. ao2g
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Printed Name