Jacquelynn PowersMIAMI 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
RECEIVED
AUG O 72024
CITY OF MIAMI BEACHOFFICEOFTHECITYCLERK
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:
M am a City of Miami Beach resident for six months or longer.
Home Address:3171 Sheridan Ave,Miami Beach,FL 33140
[}tam the parent/guardian of a student attending a Miami Beach school for +'+-school
year.
School:Innovative School of Temple Beth Sholom
D 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.c}.f"\---_iu_ly_1_1_2_02_4 _
Signature
Jacquelynn Powers
Printed Name
Date