DS-DE 41 For a Better North Beach REGISTERED AGENT OFFICE USE ONLY
STATEMENT OF APPOINTMENT 2015 SEP -�3 'i�'1 l l: ne
(Section 106.022, F.S.)
0 Original Appointment ❑ Change of Appointment
❑ Change of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information
Name Telephone
Jose Felix Diaz (305)755-5828
Street Address
1 SE 3rd Avenue, 25th Floor
City State Zip Code
Miami FL 33131
Mailing Address
8567 Coral Way, Unit 374
City State Zip Code
Miami FL 33155
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. I also understand that I may resign this appointment by executing a written
statement of resignation and filing it with the applicable filing officer.
iz 7 it J
Signaturzagistered 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
For A Better North Beach
Street Address Telephone
1 SE 3rd Avenue, 25th Floor (305)755-5828
City State Zip Code
Miami FL 33131
Signature o-Chair•ers:
Jose Felix Diaz 3"/-z-7 /15
Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)