Karin MatosCity of Miami Beach
·,o'vent,o:enter ptve
tram Beach H do 33 39
ORE OF THE C'TY CLER
Emal BC@mambeachf gov
'elehone 305 673 7411
RECEIVED
JAN 2 2 2025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
Ias(check(✓)all that apply):
~am a resident of the City of Miami Beach for six months or longer.
Home Adress !Ag duel,d Ed_Bai Eeo L.__33ilIfilIhaveanownershipinterest(for a minimum of six months)in a business established in the
City of Miami Beach (for a minimum of six months)
Name of usmess.KAih lyts 2±-~~~~~~~~~~,r-+-i:::-~-------------
usmess Address.Lf {_(cell 4v ."3y,m,a,i f@d,(234/
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).
pp3nn f [[[es,S,,
Py1me,JS]feS,
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 of perjury,I declare that I have read the foregoing document and that the facts
stated mn it are true
s,gnatur~Date 1 1
[@.on t It\
[rynted [[are +a-a