Jeannette EgoziCity of Miami Beach
1/00 Convention Center Drive
Miami Beach,Florida 33139
UN 27 20
CITY OF MLAMOFFICEOtr'mu u
OFFICE OF THE CITY CLERK
Email:BC@miamlboachfl.gov
Telephono: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),
,deck(✓)all that apply):
~I am a resident of the City of Miar:1i Beach for six months or longer.
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1z,K1 have an ownership interest (for a minimum of six months)in a bu~iness established in the
ity of Miami Beach (for a minimum of six mon[hs).
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E]1am a full-time employee of a business (for a minimum of six months)and I am based in an
offico or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
Name of Business:AJ_(_A_·_,y/Business Address:/U /]....,____,___,___
"Ownership Interest"means tho ownership of ten percent (10%)or more (including tho
ownership of 10%or more ofthe outstanding capital stock)in a business.
"Business"means any sole proprietorship,sponsorship,corporation,limited liability company,
or other entity or business association.
de}\penalties of perjury,I declare that I have read the foregoing document and that the facts
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