Prakash KumarMIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
REC EI VED
JAN 1 3 7075
AM BENGT'cm of!encOFFICEO
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (✓)all that apply):
i;a-1am a resident of the City of Miami Beach for six months or longer.
ore A«rs pg,al l,g,Au«uu (1 s,)l Mu E 3Pf
D I have an ownership interest (for a minimum of six months)in a business established in the
City of Miami Beach (for a minimum of six months).
[[are f Hyg[fess,
[y[fess [(]]reSS,
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).
[[are T [[ys[[%SS,
Hy[mes ]resS,
"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"m eans any sole proprietorship,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 document and that the facts
statedinitare true./_h_01/23/25~urP -D-a-te _
Prakash Kumar
Printed Name