DS-DE 41 Floridians for Efficiency in Government 0611112014 09:48 LSH Partners (FAX)305 673 2588 P.001/001
REGISTERED AGENT
STATEMENT OF APPOINTMENT 2014 Q11G
(Section 106.022, F.S.) !2 4H 9:
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El Original Appointment El Change of Appointment L
4 , Change of Mailing Address XChange of Physical Address
Registered Agent and Office information
Name Telephone
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Street Address
\76,AL-e._ on C1/40_ k 1/4-tt '
City State I Zlp Code 33 34+
Mailing Addres nn <,06-10(
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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• gna on - • ding it with the applicable filing officer.
F—V—N Wand lireft*Metered Agent Date
Former Registered Agent and Office Information (for changes only)
Name Telephone
Street Address
City State Zip Code
Committee or Organization Information
Na c of Committee or Or.anization
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Street Add ess .ti Telephone
l' State �j Zip Code
City �1m Go& . ` 0
Signallin4I Chairperson
een PoI( - r l - E V1
Printed Name of Chairperson Date
Form DS-DE 41(revised 6111)
0117,-11-21114