Barbara MonteroMIAMI BEACH
REC EIVED
JAN 1522
CITY OF M IAM I BEA CH
OFFICE OF THE CITY CLERK
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
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com pliance with the affi liation requirem ent of Miam i Beach City Code Sections 2-22 (4),
as (he ck (/)all that apply):
IZ]I am a resident of the City of Miam i Beach for six months or longer.
(9so Prd le,2204,446,£333 7HomeAddress:□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:_
Business Address:_
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 Miami Beach (for a
minim um of six months).
Nam e of Business:_
Business Address:--------------------------
"O wnership Interest"m eans the ownership of ten percent (10%)or m ore (including the
ownership of 10%or m ore of the outstanding capital stock)in a business.
"Business"m eans any sole pro prietorship,sponsorship,corporation,lim ited liability com pany,
or other entity or business association.
Under penalties of perjury ,I declare that I have read the foregoing docum ent and that the facts"EE>-Mr
Sign~ure Date
6UZ _W V [ere
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