Sophie RingelMIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305 .673 .7 41 l
REC EIVE
JAN 2 2 202
CITY OF M0FRice,"M M E AcOFTHECICL
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 (check(✓)all that apply):
[]I am a resident of the City of Miami Beach for six months or longer.
Hom e Address:2395 Lake Pancoast Dr,Apt.10,M iam i Beach,FL 33140
D I have an ownership interest (fo r a minimum of six months)in a business established in the
City of Miam i Beach (for a minimum of six months).
Nam e of Business:-------------------------
Business Address:_
[Z]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:Clean M iam i Beach
Business Address:2395 Lake Pancoast Dr.Apt.10,M iam i Beach,FL 33140
"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 company,
or other entity or business association.
Under penalties of perjury ,I declare that I have read the foregoing docum ent and that the facts
stated in it are true.536.a 1/1702s-------------Signature
Sophie Ringel
Printed Nam e
Date