DS-DE 4 Appointment of Campaign Treasurer A
REGISTERED AGENT OFFICE �4 �•���
STATEMENT OF APPOINTMENT ? Nr of S
(Section 106.022, F.S.) lyaR""3 Ark
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Q originai Appointment D Change of Appointment 48�Ss�FC�Zlo*s
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❑Change of Maifing Address ❑Change of Physical Address
Registered Agent and Office Information
Name Joey Galleno Telephone 305-904-1272
Street Address 1 640 NW 17 Ave.
city Miami state Florida Zip Code 33125
Mailing Address 1 640 NW 17 Ave.
City Miami state Florida Zip Code 33125
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. understand that I may resign this appointme by executing a written
statement of resignation apoMft it with the Division of Elections.
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Sig f Registered Agent Date
Former Registered Agent and Office Information (for changes only)
Name Jennifer Blohm Telephone 850-878-5212
street Address 131 North Gadsden Street
city Tallahassee state Florida Zip code 32301
Committee or Organization Information
Name of Committee or Organization
Citizens for Ethical and Effective Leadership
street Address 8306 Mills Drive, #374 T hone
City Miami State Florida Zip code 33183-4838
Committee or organization is registered with:
[Z] DivisjQQ of Elections ❑ County ❑ City
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SlgnatuWCVA-Iroirson
Daniel Cifuentes Z
Print Name of Chairperson Date
Form DS4DE 41(mvised 1109)