G:\Zoning 2009\Forms and Sample documents\Website Documents\BTR\Affidavits\ club_aff.pdf Modified: 10.23.2012
City of Pompano Beach
Department of Development Services
Business Tax Receipt Division
100 W. Atlantic Blvd Pompano Beach, FL 33060
Club Affidavit
Phone: 954.786.4668 / 954.786.4633 Fax: 954.786.4666
State of Florida}
County of Broward}
I _______________________________ am the __________________________ of the proposed business known as
(Print Name) (Title)
_______________________________ to be located at ______________________________________ in the City of
(Business Name) (Address)
Pompano Beach and authorized to sign on behalf of the business hereby acknowledged that I have been given a copy
of, understand and will insure the business will abide by the provisions of Section 155.003 of the City of Pompano
Beach Code of Ordinance which establishes specific limitations in order to operate a “Club”. These limitations
include but are not limited to being a chartered incorporated club pursuant to State Law, having a bona fida
membership and the club has been in continuous existence as has operating for a period of not less than two years in
Broward County.
Signature: ________________________________
SWORN TO AND SUBSCRIBED before me this
____ day of _______________ 20 ____, in Pompano Beach, Broward County, Florida.
_____
_______________________________
Notary Public Notary Public, State of Florida
Seal of Office
___________________________________
(Print Name of Notary Public)
_______ Personally Known
_______ Produced Identification
Type of identification produced:
___________________________________
