DS-DE 41 MB Residents First i
REGISTERED AGENT OFFICE USE Of(lLY o
STATEMENT OF APPOINTMENT m
(Section 106.022, F.S.) r— r
rn N
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CJ7 'r7 i
❑ Original Appointment ❑ Change of Appointment _
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❑ Change of Mailing Address Change of Physical Address N
NN Registered Agent and Office Information
&BhIA MAGGIOLO
Telephone 200
2121tPOdNCE DE LEON BLVD STE 1100
88RAL GABLES �State 3104 e
SA�M9 ASdA�OVE
City State 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 understand that I may resign this appointment by executing a written
statem Anof r gnation and filin it ith the applicable filing officer.
20
S�9114ure of Register A ' 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
MIAMI BEACH RESIDENTS FIRST
901AAd h GODFREY ROAD STE 401 k -'Me7626
MIAMI EACH Vpop148de
onar hai rperson
TOVAH GOLDFARB
Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)
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
MIAMI BEACH, FL 33140
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 N/A N/A
8. List Any Issues this Committee is Supporting: MIAMI BEACH RESORT TAX INCREASE
List Any Issues this Committee is Opposing: N/A
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?
RETURNED PRO-RATA TO CONTRIBUTORS OR GIVEN TO CHARITABLE 501 C3
ORGANIZATION
11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository &Account Number Mailing Address
WELLS FARGO BANK, N.A. 750 ARTHUR GODFREY ROAD
MIAMI BEACH, FL 33140
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
N/A N/A N/A N/A
STATE OF FLORIDA MIAMI-DADE COUNTY
TOVAH GOLDFARB
I, certify that the information in this Statement of
Organization is omplete, ue and correct.
X ���
Lgnat a of Chairman of Political Committee Date