ReformMB.com DS-DE 41 REGISTERED AGENT OFFICE USE ONLY
STATEMENT OF APPOINTMENT c-, o
(Section 106.022, F.S.) o
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0 Original Appointment ❑ Change of Appointment Qt
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❑ Change of Mailing Address ❑ Change of Physical Address �?
Registered Agent and Office Information c.0
Name Ronald Meyer Telephone (850)878 -5212
Street Address 131 No rth Gadsden Street
City Tallahassee Stat Florida Zip Code 32312
Mailing Address 131 No rth Gadsden Street
City Tallahassee State Florida Zip Code 32312
I accept this appointment and confirm that I am familiar with and accept the obligations of the position as set
forth in Section 106.022, F.S. I also understand that I may resign this appointment by executing a written
statement of resignation and filing it with the Division of Elections.
Signature of Registered Agent Date
Former Registered Agent and Office Information (for changes only)
Name Telephone
Street Address
City State Zip Code
Committee or Organization Information
Name of Committee or Organization
ReformMB.com, Inc.
Street Address 7455 Collins Avenue Telephone 305- 861 -1190
City Miami Beach State Florida Zip Code 33141
Committee or organization is registered with:
❑ Division of Elections ❑ County p City Miami Beach
ign ure o hairperson
Joseph Fisher / O — - - ?. \�
Print Name of Chairperson Date
Form DS -DE 41 (revised 1/09)
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6. List by Name, Address and Position, Other Principal Officers, Including Officers and Members of the
Finance Committee, If Any (include chairman's name)
Full Name Mailing Address Committee Title or Position
Joseph Fisher 7455 Collins Avenue, Suite 212 Chairman
Miami Beach, Florida 33141
7. List by Name, Address, Office Sought and Party Affiliation Each Candidate or Other Individual that this
Committee is Supporting (if none, please indicate)
Full Name Mailing Address Office Sought Party
N/A
8. List Any Issues this Committee is Supporting: To Be Determined
List Any Issues this Committee is Opposing: To Be Determined
9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party
N/A
10. In the Event of Dissolution, What Disposition will be Made of Residual Funds?
Contributed to charity tax exempt pursuant to Section 501(c)(3) of the Internal Revenue Code
11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository & Account Number Mailing Address
Bank of America - Acct # 229032784308 3801 Hollywwod Blvd
Hollywood, Florida 33021
12. List all Reports Required to be Filed by this Committee with Federal Officials and the Names, Addresses
and Positions of Such Officials, If Any
Report Title Dates Required to be Filed Name & Position of Official Mailing Address
Form 990 or 990 -N Annually IRS Ogden, UT
STATE OF Florida Broward COUNTY
Joseph Fisher , certify that the information in this Statement of
Organization is complete, true and correct.
7 Si'nature • Chairman of Political Committee Date