Steve PolisarMIAMI BEACH
RECEIVED
SEP %6 2024
CITY OF MIAMI BEACH
OFFICE OTHE CITY CLERK
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
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;2015 MARSEILLES DRIVE (moved)
[EI 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.ttorney at Law -407 Lincoln Road,Suite 2A,Miami Beach,FL
Business Address:1971 71 STREET,MIAMI BEACH,FL 33141 (Property)
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).
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.
Under penalties~f ~r ury,I declare that I have read the foregoin.g document and that the facts"J -/d 9er z!2oz4Sia{nan,,G DateStevePlisa
Printed Name