Citizens for Miami Beach's Future PAC REGISTERED AGENT OFFICE USE ONLY
STATEMENT OF APPOINTMENT 2013 SEA' 13 F.'4112: 22
(Section 106.022, F.S.)
,IT
L =it `t S l�r E
❑✓ Original Appointment ❑ Change of Appointment
❑ Change of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information .
Name Telephone
Ana Cecilia Velasco 305/674-1300
Street Address
1920 Meridian Avenue
City State Zip Code
Miami Beach Florida 33139
Mailing Address
1920 Meridian Avenue
City State Zip Code
Miami Beach Florida 33139
I accept this appointment and confirm that I am familiar with and accept the obligations of the position as set
forth in ctio 106.02 S. I also understand that I may resign this appointment by executing a written
statem t of re ' n f g it with the applicable filing officer.
I �
Signa ure of egistered Agent Date
Former Registered Agent and Office Information (for changes only)
Name Telephone
N/A
Street Address
City State Zip Code
Committee or Organization Information
Name of Committee or Organization
Citizens for Miami Beach's Future
Street Address Telephone
1920 Meridian Avenue 305/674-1300
City State Zip Code
Miami B ch Florida 33139
Sign a of Chairperson
Ana Cecilia Velasco
Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)
r--a- I %,, r
i2� Z i I�� 13 P��
APPOINTMENT OF CAMPAIGN TREASURER 2013 S
AND DESIGNATION OF CAMPAIGN C i T`+ C LIE- C I F I C E
DEPOSITORY FOR
POLITICAL COMMITTEES
(Sections 106.011(1)and 106-021(1),F.S.)
CHECK APPROPRIATE BOX: OFFICE USE ONLY
® Original Appointment of Treasurer El Reappointment of Treasurer Deputy Treasurer
1.Committee or Organization 2.Telephone
Citizens for Miami Beach's Future (305 ) 674-1300
3. Name of Treasurer or Deputy Treasurer 4. Email(optional) 5.Telephone(optional)
Adam Cedrati ( )
6.Mailing Address
1001 Brickell Bay Drive, Suite 1400, Miami, Florida 33131
7.Street Address
1001 Brickell Bay Drive, Suite 1400, Miami, Florida 33131
8.The following bank has been designated as the rxj Primary Depository ® Secondary Depository
9. Name of Bank 10.Street Address
City National Bank 300 71 st Street
11.City 12.State 13.Zip Code
Miami Beach Florida 33141
14.Signature of Chairman 15. Name of Chairman(Print or Type)
X Ana Cecilia Velasco
Camnaion Treasurer's Acceptance of Appointment
I Adam Cedrati ,do hereby accept the appointment as
(Please Print or Type)
treasurer or deputy treasurer for Citizens for Miami Beach's Future
(Committee or Organization)
UNDER PENALTIES OF PERJURY,I DECLARE THAT 1 HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
f/3 J0013 X
Date i nature of Campaign Treasurer or De put Treasurer
DS-DE 6(Rev.7/10)
F CE ONLY
STATEMENT OF ORGANIZATION 2G 3 USE ON ON 12: 21
OF POLITICAL COMMITTEE C 1 `,L „t,- !
0FVWE
(PLEASE TYPE)
1. Full Name of Committee Telephone
Citizens for Miami Beach's Future 305/674-1300
Mailing Address(include city, state and zip code)
1920 Meridian Avenue, Miami Beach, Florida 33139
Street Address(include city, state and zip code)
1920 Meridian Avenue, Miami Beach, Florida 33139
2.Affiliated or Connected Organizations(includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization Mailing Address Relationship
Miami Beach Chamber 1920 Meridian Avenue Affiliated organization
of Commerce Miami Beach, Florida 33139
3.Area,Scope and Jurisdiction of the Committee
City of Miami Beach issue political committee to discuss municipal improvements and increased
quality of life for City residents.
4. Nature of Organization or Organization's Special Interest(e.g., medical, legal,education, etc.)
Political
5. Identify by Name,Address and Position,the Custodian of Books and Accounts (include treasurer's name)
Full Name Mailing Address Committee Title or Position
Adam Cedrati Mallah Furman & Co. CPA Treasurer
1001 Brickell Bay Drive, Suite 1440
Miami, Florida 33131
DS-DE 6(Rev.05/06) (continued on reverse side)
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
Ana Cecilia Velasco 1920 Meridian Avenue Chairman, Deputy Treasurer
Cristian Galleguillos Miami Beach, Florida 33139 Deputy Treasurer
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 �t�art
�k
N/A
t C
.v
y
8. List Any Issues this Committee is Supporting:To be determined �-, =3' TT
List Any Issues this Committee is Opposing: To be determined
.7
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?
Contribute to other political committees or other activities not prohibited by law.
11. List all Banks, Safety Deposit Boxes,or Other Depositories Used for Committee Funds
Name of Bank or Depository&Account Number Mailing Address
City National Bank 300 71st Street
Miami Beach, Florida 33141
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 8871 Upon formation Internal Revenue Ogden, UT 84201
Form 1120POL March 15, annually Service
Form 990, May 15, annually
as may be required
STATE OF Florida Miami-Dade COUNTY
Ana Cecilia Velasco , certify that the information in this Statement of
Organization is plete,tru ra ect.
X
re of Chairman bf Political Committee Date
1
APPOINTMENT OF CAMPAIGN TREASURER 2013 SEP 13 PN 12: 22
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR
�IT�'f CL_���tR'd'� Gt=f 1H
POLITICAL COMMITTEES
(Sections 106.011(1)and 106.021(1),F.S.)
CHECK APPROPRIATE BOX: OFFICE USE ONLY
® Original Appointment of Treasurer Reappointment of Treasurer ® Deputy Treasurer
1.Committee or Organization 2.Telephone
Citizens for Miami Beach's Future (305 ) 674-1300
3. Name of Treasurer or Deputy Treasurer 4. Email(optional) 5.Telephone(optional)
Ana Cecilia Velasco ( )
6. Mailing Address
1920 Meridian Avenue, Miami Beach, Florida 33139
7.Street Address
1920 Meridian Avenue, Miami Beach, Florida 33139
8.The following bank has been designated as the a Primary Depository rj Secondary Depository
9. Name of Bank 10.Street Address
City National Bank 300 71 st Street
11. City 12. State 13.Zip Code
Miami Beach Florida 33141
14. Signature of Chairman 15. Name of Chairman(Print or Type)
X Ana Cecilia Velasco
Campaign Treasurer's Acceptance of Aaaointment
I Ana Cecilia Velasco ,do hereby accept the appointment as
(Please Print or Type)
treasurer or deputy treasurer for Citizens for Miami Beach's Future
(Committee or Organization)
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE RE E FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT HE F� CTS S , ARE TRUE.
X
ate a ure o am ai n Treasurer or De2uty Treasurer
DS-DE 6(Rev.7110)
L'
?613 SEp P
APPOINTMENT OF CAMPAIGN TREASURER f : 2�
AND DESIGNATION OF CAMPAIGN ��l(,�': (�� ;Yy1'S
DEPOSITORY FOR �' ►�l!;
POLITICAL COMMITTEES
(Sections 106.011(1)and 106.021(1),F.S.)
CHECK APPROPRIATE BOX: OFFICE USE ONLY
0 Original Appointment of Treasurer Reappointment of Treasurer EN Deputy Treasurer
1. Committee or Organization 2.Telephone
Citizens for Miami Beach's Future (305 ) 674-1300
3. Name of Treasurer or Deputy Treasurer 4. Email(optional) 5.Telephone(optional)
Cristian Galleguillos ( )
6. Mailing Address
1920 Meridian Avenue, Miami Beach, Florida 33139
7. Street Address
1920 Meridian Avenue, Miami Beach, Florida 33139
8.The following bank has been designated as the ® Primary Depository ® Secondary Depository
9. Name of Bank 10. Street Address
City National Bank 300 71 st Street
11. City 12. State 13.Zip Code
Miami Beach Florida 33141
14.Signature of Chairman 15. Name of Chairman(Print or Type)
X Ana Cecilia Velasco
Campalan Treasurer's Acceptance of ADaointment
C ri sti a n G a l l eg u i l l os ,do hereby accept the appointment as
(Please Print or Type)
treasurer or deputy treasurer for Citizens for Miami Beach's Future
(Committee or Organization)
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND TH T E FAC S STATED ARE TRUE.
Date Si nature Campaign Treasurer or Deputy Treasurer
DS-DE 6(Rev.7/10)