HomeMy WebLinkAboutCSW Residency Compliance Form 2014-10-09CITY OF MIAMI, FLORIDA
RESIDENCY COMPLIANCE FORM
(IN CONFORMANCE WITH SECTION 2-884 OF THE CITY CODE)
Please submit your completed form to:
Office of the City Clerk
3500 Pan American Drive
Miami, FL 33133
I' En9 craw' , a'ma` ` H & ,-\ x k'
(Last Name, First Name, Middle Name OF THE BOARD MEMBER)
CO M m tss� orT 5-i-Ck S 0 4 w mein
(PRINT NAME OF THE BOARD)
, a member of the
DO ❑ DO NOT comply with the residency requirement under Code Section 2-884,
namely:
"(a) All members of the City boards shall either be permanent residents of the City, own
real property in the City, or work or maintain a business in City..."
(Note: If you do comply with the residency requirement (Code Sec. 2-884), please provide
us with the following information)
A. I presently reside in the City of Miami at the following address:
g00 M 'QJ
►-- ► alm' , EL- 33 ' 5 O
B. I own a business and/or real property within the City of Miami limits at the following
address: (Note: Kindly specify if it is a business or a property)
c
rI
•
a
r— r if
(—)
C. I work within City of Miami limits. My business address is:
SI/YYILjLuVi;nit'
30/2o
Date
General Residency Form; Last Revised: January 2011