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David WallackMIAMI BEACH City of Miami Beach 1 700 Convention Center Drive Miami Beach,Florida 33139 OFFICE OF THE CITY CLERK Email:BC@miamibeachfl.gov Telephone:305 .673 7411 RECEIVED SEP 04 2024 CITY OF MIAMI BEACH OFFICE Or r CITY CLERK 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): D I am a resident of the City of Miami Beach for six months or longer. Home Address:-------------------------- ~ave 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 ot Business:._P]nu4o's 1RP4 "arE Business Address:qoo OcEk Dea2DIamafull-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 of the outstanding capital stock)in a business. "Business"means any sole proprietorship,sponsorship,corporation,limited liability company, or other entity or business association. ?SoiPeJy,I declare that I have read the foregoing document and that the facts z1/2% Date I I Printed Name