HomeMy WebLinkAboutresidency-3CITY OF MIAMI, FLORIDA
RESIDENCY COMPLIANCE FORM
Please submit your completed form to:
City of Miami
Office of the City Clerk
3500 Pan American Drive
Miami, Florida 33133
Date:
I, L,e)/ // & '' 6-7
-n
•
r- v,
0
z
.."1:7
0
, a member of
(name of board)
dv
(do/do not)
comply with the residency requirement:
(Note: If you do comply with the residency requirement, please provide us with the
following information.)
I presently reside in the City of Miami at the following address:
'70
Sig
tore Sig ature
rri