Laura Levey (2)MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach,Florida 33139
RECEIVED
JUL 11 2024
CITY OF MIAMI BEACHOFFICEOFTHECITYCLERK
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):
~I am a resident of the City of Miami Beach for six months or longer.
tor»A«or»s..622 Culls hy_At e Py.-□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 or uses».lot,o (&uard
ausmess Adress:l6@ Marilu@__At.3t.q00 1,3312
D 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).
Lg,Laa)fl3j%al@s ha •±o
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
state •it are true.R.aSignaturelava2
.(sh"f
Printed Name I