Better Miami Beach DS-DE 41 REGISTERED AGENT OFFICE i O,NLY
STATEMENT OF APPOINTMENT
(Section 106.022, F.S.) I'll JAN 23 PM 3: 02
CITY CLLER S
Original Appointment ❑ Change of Appointment
❑ Change of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information
Name Telephone
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Street Address
City State Zip Code
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Mailing Address
City State Zip Code
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1 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 resign do nd fili it with the applicable filing officer.
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Sig natu re/qAegiiered Agent Dat
L'I�ormer 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
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Street Address Telephone
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City AA 0AM 1 �'� State Zip Code I
33 31
Signature of Ch ' p on
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Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)
5. List by Name, Mailing and Street Address, and Position, Other Principal Officers, Including the Treasurer
and Deputy Treasurer, If Any(Include the Top-ranking Officer's(e.g., Chairperson) Name and Information)
Full Name Mailing Address Street Address Title or Position
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6. In the Event of Dissolution,What Disposition will be Made,of the Residual Funds?
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7. List All Banks, Safety Deposit Boxes, or Other Depositories Used by this Organization for Electioneering
Communications
Name of Bank or Depository Mailing Address
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8. List All Reports Required to be Filed by this Organization 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
STATE OF �a�� ocm I— JA])(- COUNTY
I, pa V , certify that the information in this Statement
of Organization is complete, t corre
Signature of Top-ran i g Pri cipal Officer of Organization Date
Form DS-DE 103(Rev. 10112)—page 2 of 2 Note: If necessary,continuation sheets should be used to complete the form.