The Afterparty DS-DE 41 REGISTERED AGENT OFFICE USE ONLY
RFEIVFD
STATEMENT OF APPOINTMENT C
(Section 106.022, F.s.) 2011 MAR -1 PM 14: 28
CITY CLERK'S OFFICE
0 Original Appointment ❑ Change of Appointment
❑ Change of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information
Name Ronald Malone Telephone
317 409 6056
Street Address 600 NE 36 St. #1718
City Miami State FL Zip Code
Mailing Address
600 NE 36 St. #1718
City Miami State FL Zip Code
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 resig =ti• ; .' d Iin• it with the Division of Elections.
4,4
Signature of Registered A•ent 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
The Afterparty
Street Address Telephone
600 NE 36 St. #1718 317 409 6056
City State FL Zip Code 33137
Committee or organization is registered with:
❑ Division of Electio s ❑ County p City Miami Beach
Signature of Chairpers •
gNct1.b x) (c1419— L A4
Print Name of Chairperson Date
Form DS -DE 41 (revised 1 /09)