Christine Perrin-Stoccon
Sity of Miami each'OO Convention Center DriveMiamiBeach,Florida 33139./'gcE or mt crcask5"pal:BC@miamtbeach.govelephone:305.673.7411
M
AFFIDAVIT OF AFFILIATIONWITHTHE CITY OE MIAMLBEACH
pliance with theaffiliation requiren nt amt '(/)all that apply):'''.ement of Miami Beach City Code Sections 2-22 (4),
¥"/t }
m a resident of ·«o...:a ·to
:lll ah-ome Aaares.a"j
I havean ownership inte
C
·t f M.·.'·.1 •~tal'!Jlis\iiej im Ui\e
ity of iami Beach (for a minimum of six months).'
Nz :..l'{¢,l [,lame of Business:.'did___L4 Lss,1
usiness Address:_W to0y-u a 7"7
lama full-time employee usiness (for°an?lj To 'office or other location tor a
minimum of six monthI,
H3uSin@5bl
,ddfCS.
-"Ownership Interest"means the 0 roe.or more (including the
ownershipof 10%or more ofthe outstandifi al ck)+%8°·
"Business"means anysole proprietorship,spons p,corporation,limited liability comP@
or other entity or business association.
Under penalties of perjury,I declare that I have read the foregoing document and that the fa0°
stated in it are true.tX'-
Rm_-cc0
Date
l