Lee Zimmerman (2)MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
RECEIVED
AUG 0 8 2024
CITY OF MIAMI BEACHOFFIOor"I IT CLERK
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(check0 al that apply):
E2f I am a resident of the City of Miami Beach for six months or longer.
Home Address:
~have an owne-rs-h-ip_i_n-te-r-es_t_(_fo_r_a_m-in-im-um_o_f_s-ix_m_o_n_th_s_)-in_a_b-us-i-ne_s_s_e_s_t-ab-1-is_h_e_d-in-the
city ot Mari each toa minimum o st»mohs-,,[_[(
an-ors».,_f _9el hadst]4_
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IDIamafull-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 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;ssSignature)DateleL[uh/n
Printed Name
Business Address: