DS-DE 41 Save Miami Beach 2016 REGISTERED AGENT OFFicE;USE,ONLV
STATEMENT OF APPOINTMENT ►SPY J � �
(Section 106.022, F.S.)
C17 'I' CLC.i,L j I .. _
Original Appointment ❑ Change of Appointment
ElChange of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information
Name G ~'N�I (.4‘ Telephone ` t7,5'
Street Address os I rin /chic, 1-3
City r6 State_FL Zip Code 3 3 ? �l
Mailing Address
City State Zip Code
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
state t of resigna n and filing it with he plicable filing officer.
Signature of R istred Agent Date
9 � 9
Former Registered Agent and Office Information (for changes only)
Name C\ Cr Telephone
Street Address
City State Zip Code
Committee or Organization Information
Name of Committee or Organization gfkAy__ ^/4I01` cD /6
Street Address j O S f c.(44 ` /3.j 6 14-3 Telephone se"7 c j3
City State Zip Code
CAIJA0
Signature of Chairperson
cv„ita4, d`_--d
Printed Name of Chairperson Date
Form DS-DE 41 (revised 6/11)