DS-DE 41 Miami Beach Advisory Council STATEMENT OF APPOINTMENT •
REGISTERED AGENT OFFICE4USE ONLY
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STATEMENT OF APPOINTMENT
(Section 106.022, F.S.) 20R DEC 26 AN 10: 35
CITY _
O F IC E
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0 Original Appointment ❑ Change of Appointment
❑ Change of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information
Name Telephone
Mark Herron 850-567-4878
Street Address
2618 Centennial Place
City State Zip.Code
Tallahassee FL 32308
Mailing Address
P.O. Box 1701
City State Zip Code
Tallahassee FL 32302-1701
I accept this ap••intment and confirm that I am familiar with and accept the obligations of the position as set
forth in Sectio 06.022, F.S. I also understand that I may resign this appointment by executing a written
statem-nt • r: • ation and filing it with the applicable filing officer.
, 16 December 2014
Signat a of egistered Agent 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 Advisory Council
Street Address Telephone
2618 Ce tennial Place 850-567-4878
City State Zip Code
Tallahass e FL 32308
Signat e of C airperson
Mark Herron 19 December 2014
Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)