DS-DE 41 Guardians of Miami Beach REGISTERED AGENT A
�~� � OFFICE,_USE O,NLY
STATEMENT OF APPOINTMENT
(Section 106.022, F.S.) MAY 26 2015
CITY � I It9, OFFICE
•
51 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 his appoint • nt and confirm that I am familiar with and accept the obligations of the position as set
forth in •ection 10. I 7, F.S. I also understand that I may resign this appointment by executing a written
statem= t o .gn. • and filing it with the applicable filing officer.
21 May L
2015
Signatur: of Regi- ered Agent Date
For er 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
Guardians of Miami Beach
Street Address Telephone
2618 Ce tennial Place 850-567-4878
City State Zip Code
Tallaha ee FL 32308
Signat re of Ch ir,person
Mark Herr. 21 May 2015
Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)