Melissa Berthier11Al
RECEIVED
JUL 23 2024
CITY OF MIAMI BEACH
OFFICE O HE CITY CLERK
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
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.
Home Adare.5750 Collins Ave,16J Miami Beach,FL 33140
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:City of Miami Beach
Business Address:1700 Convention Center Drive Miami Beach,FL 33139
"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.
Melissa Berthier
Signature
Mel ·,ssa Berth ·,er Digitally signed by Melissa BerthierDate:2024.07.23 10:38:13 -04'00'
Printed Name
7/23/24
Date