Chana Levin EisnerMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.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:
th am a City of Miami Beach resident for six months or longer.
H Add 4101 Pine Tree Dr,Apt 804,Miami Beach FL 33140/ome ress:
[]tam the parent/guardian of a student attending a Miami Beach school for ti &+-school
year.
School:Yeshiva Elementary School
LJ My parent/legal guardian requirement has been waived by the City Commission.
Under penalties of perjury,I declare that I have read the foregoing document and that the facts
stated in it are true.[M/ozozoz4-------------Signature
Chana Levin Eisner
Printed Name
Date