DS-DE 103 Appointment of Campaign Treasurer ELECTIONEERING COMMUNICATION RECE
0 ED
STATEMENT OF ORGANIZATION
EPA R-,
_;:L' lyNr OF STATE
(PLEASE TYPE) 2010 JUL _2 PM 12:
7
IDIVIS107 OF
A LL aHA S 0(qg ONLY
1.Full Name of OrganhwMon Telephone
Citizens for Ethical and Effective Leadership 305-588-5693
Mailing Address(include city,state and zip code)
8306 Mills Drive,#374, Miami, FL 33183
Street Address(include city,state and zip code)
8306 Mills Drive,#374, Miami, FL 33183
2.Affiliated or Connected Organizations
Name of Affiliated or Mailing Address Relationship
Connected Organ¢a6on
NIA N/A NIA
3.Area,Scope and Jurlsdlcdon of the Organization
State of Florida
4.Identify by Name,Address&Position,the Custodian of Books&Accounts for the Organizadon
Full Name Mailing Address Street Address Title or Position
Daniel Cifuentes 8306 Milts Drive, 8306 Mills Drive, Treasurer
#374, Miami, FL #374, Miami, FL
33183 33183
IL
5. This Organization was loin (dwelt applicable box): (Calendar quarters end the last day of March,June,
September,and December.)
C] As a newly created organization during the current calendar quarter.
® From an organization existing prior to the current calendar quarter.
Form DS-DE 103(Rev.06110) (continued on reveme)
s
S.List By Nam,Mailing and Street Address,S Position,Other Principal Queers,including the treasurer and
deputy treasurer,If an include chat n's name and information
Full Name Mailing Address Street Address Title or Position
Daniel Cifuentes 8306 Mills Drive, 8306 Mills Drive, Chairman &Treasurer
#374, Miami, FL #374, Miami, FL
33183 33183
7.List By Name,Address,Office Sought,&Party Affiliation,Each Candidate or Other Individual that this
Organization Is Supporting
Full Name Mailing Address Office Sought Party
To be determined n/a n/a n/a
8.In the Event of Dissolution,What Disposition will be Made of the Residual Funds?
Pro-rata to contributors or to US 501 (c)(3)organization(s)
9.List All Banks,Safety Deposit Boxes,or Other Depositories Used by this Organization for Electioneering
Communications
Flame of Bank or Depository Mailing Address
Bank of America 6901 SW 117 Ave., Miami, FL 33183
10.List All Reports Required to be Filed by this Organization with Federal Officials,&the Names,Addresses,
&Positions of Such Officials,N Any
Report Title Dates Required to be Filed Name&Position of Official Mailing Address
a. Form 8871 a.24 hours of re-registedng IRS IRS
b. Form 1120-POL with FL DOE Ogden, LIT 84201
b.3 months after calendar year
c. FOm1 990 c.5 months after calendar year
STATE OF Florida Miami-Dade COUNTY
I Daniel Cifuentes ,certify that the inlorma ion in this Statement of
Organization is complete,truer correct.
X
Signatu rson of Organization Date
Form DS-DE 103(Rev.W10)—page 2 of 2 Note: If necessary,continuation sheets should be used to complete the form.