Johann MooreEmail:BC@miamibeachfl.gov
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 Address:___________________________________________________________
□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.
Signature Date
Printed Name