Beatriz HerrmannRECEIVED
AUG 0«2074
E MIAMI BEACHCITYO,«e clcEnKOFFICE""'
Cisty #ioi @ksec.h
700 Convention Center Drive
Miami Beach,Florida 33139
OFCE OF THE CNY CLERK
Email:.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):
00 I am a resident of the City of Miami Beach for six months or longer.
ore.ass o!otl at6coo Pua heel.Et
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:~rl-'-'-/_;f _
Business Address:-,-}_~_1/__..;;_·_.._·_
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).8•d2NameofBusiness:~trH\-v_,_;1--{-7......,____
[[]][@,,J][PS3,-
"Ownership Interest"means the ownership of ten percent (10%)or more (including the
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.
Under penalties of perjury,I declare that I have read the foregoing document and that the facts
stated in it are true.
Kt,ors
,Signature j
Bf112 ILE LIL)
Printed Name
7