Carol MotleyMIAMI 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 .7 411
RECEIVE#.
JAN 142
CiTY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com pliance 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.
Hom e Address:_
D I have an ownership interest (for a minimum of six months)in a business established in the
City of Miam i Beach (fo r a minimum of six months).
Nam e of Business:._
Business Address:_
Z]am a full-tim e em ployee 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).
Nam e of Business:GM CVB·-------------------------
Business Address:1901 Convention Center Drive,M iam i Beach,FL 33139
"O wnership Interest"m eans the ownership of ten percent (10%)or more (including the
ownership of 10%or m ore of the outstanding capital stock)in a business.
"Business"means any sole pro prietorship,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
stated in it are true..<>
Caro l M otley
Printed Nam e
1.10.2025
Date