Sipiwe AndersonMIAMI BEACH
R ECE IVE D
JAN 16 2025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach
1700 Convention Center Drive
M iami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Em ail:BC@ miam ibeachfl.gov
Telephone:305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com pliance with the affiliation requirem ent of Miam i Beach City Code Sections 2-22 (4),
as (check (/)all that apply):
[Z]I am a resident of the City of Miam i Beach for six months or longer.
Home Address,8 125 Crespi Blvd #1 M iam i Beach,FI 33141
[Z]I have an ownership interest (for a minimum of six months)in a business established in the
City of Miam i Beach (for a minim um of six months).
Nam e of Business.US-Skin Consultant LLC
Business Address.8125 Crespi Blvd #1 M iam i Beach FI 33141
D I am a full-tim e em ployee of a business (for a minim um of six months)and I am based in an
office or other location of the business that is physically located in Miam i Beach (for a
minim um of six months).
Nam e 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.
,I de lare that I have read the fo regoing docum ent and that the facts
Si nature
Sipiw e Anderson
01-15-2025
Date
Printed Nam e