DS-DE 5 MB Citizens Alliance PAC, Inc. Statement of Organization of Political Committee
OFFICE USE ONLY
STATEMENT OF ORGANIZATION
OF POLITICAL COMMITTEE Ci ~
~ s ';0
-< :s m
() ~
(PLEASE TYPE) r -< (")
r'i , :'"11
,rJ -
1. Full Name of Committee Telephone :;; .." <::
:x rr
0
Miami Beach Citizens Alliance ?i\C) ~c. -T1 s:- C
(305) 86~8%
("") 0
Mailing Address (include city, state and zip code)
4045 Sheridan Avenue #36? Miami Beach FL 33140-3665
Street Address (include city, state and zip code)
Same as above
2. Affiliated or Connected Organizations (includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization Mailing Address Relationship
None N/A N/A
3. Area, Scope and Jurisdiction of the Committee
To promote equitable taxation
4. Nature of Organization or Organization's Special Interest (e.g., medical, legal, education, etc.)
Educational
5. Identify by Name, Address and Position, the Custodian of Books and Accounts (include treasurer's name)
Full Name Mailing Address Committee Title or Position
Sheila Jaffe 4045 Sheridan Avenue #362 Treasurer
Miami Beach FL 33140-3665
OS-DE 5 (Rev. 05/06)
(continued on reverse side)
6. Ust by Name, Address and Position, Other Principal Off"tCeI'S, Including Officers and Members of the
Finance Committee, If Any (include chairman's name)
Full Name Mailing Address Committee Title or Position
~ 4045 Sheridan Avenue #362 Chairman
Jeff . Gibbs
Miami Beach FL 33140-3665
-
7. List by Name, Address, Office Sought and party Affiliation Each Candidate or Other Individual that this
Committee is Supporting (if none, please Indicate)
FuH Name Mailing Address Office Sought Party
None at this time N/A N/A N/A
8. List Any Issues this Committee is Supporting: Equitable taxation issues
Ust Any Issues this Committee is Opposing: N/A
9. If this Committee is Supporting the Entire TICket of a Party, Give Name of Party
N1A
10. In the Event of Dissolution, What Disposition will be Made of Residual Funds?
Donation to charity
11. Ust aU Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository & Account Number Mailing Address
Wachovia 750 Arthur C'~Trey !bad
12000021160147 ~.i.ami Beach FL 33140
12. List all Reports Required to be Filed by this Committee with Federal Officials and the Names, Addresses
and Positions of Such Officials, If Any
Report Trtle Dates Required to be Filed Name & Position of Official Mailing Address
None N/A N/A N/A
STATE OF FLORIDA MIAMI-DADE COUNTY
I, Je~L Gibbs , certify that the information in this Statement of
;~":Jis.:'e::7r]~~j1 c;if - /J...o 1
( :>igr ~ Jr~ of r r..~i~'" of Political Committee Date
r
\ vV \j