DS-DE 6 & DS-DE 103 Appointment of Campaign Treasurer
ELECTIONEERING COMMUNICATION OFFICE USE ONLY
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STATEMENT OF ORGANIZATION ~' ~
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(PLEASE TYPE) _ tv `~
1. Full Name of Organization Telephone ~~
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Floridians for Ethical Government 305-666-1$~8 ~
Mailing Address (include city, state and zip code)
7525 SW 54th Ct, Miami, FL 33143
Street Address (include city, state and zip code)
7525 SW 54th Ct., Miami, FL 33143
2. Affiliated or Connected Organizations
Name of Affiliated or
Connected Organization Mailing Address Relationship
None
3. Area, Scope and Jurisdiction of the Organization
State of Florida -- Candidates and Issues.
4. Nature of Organization or Organization's Special Interest (e.g., medical, legal, education, etc.)
Government
5. Identify by Name, Address 8 Position, the Custodian of Books 8~ Accounts (include treasurer's name)
Full Name Mailing Address Committee Title or Position
Keith Donner 7525 SW 54th Ct. Treasurer
Miami, FL 33143
Form DS-DE 103 (Rev. 05106) (continued on reverse)
6. List By Name, Address, 8~ Position, Other Principal Officers, Including Officers 8~ Members of the Finance
Committee, If Any (include chairperson's name)
Full Name Mailing Address Committee Title or Position
Keith Donner 7525 SW 54th Ct ChairpersonlTreasurer
Miami, FL 33143
7. List By Name, Address, Office Sought, ~ Party Affiliation, Each Candidate or Other Individual that this
Organization Is Supporting
Full Name Mailing Address Office Sought Party
To Be Determined
8. List Any Issues this organization is supporting: TO be determined
List Any Issues this Organization is Opposing: To be determined
9. If this Organization is Supporting the Entire Ticket of a Party, Give Name of Party
N/A
10. In the Event of Dissolution, What Disposition will be Made of the Residual Funds?
Pro rata refunds to contributors or gifts to organizations exempt under 501(c)(3) of IRS Code.
11. List All Banks, Safety Deposit Boxes, or Other Depositories Used by this Organization for Electioneering
Communications
Name of Bank or Depository & Account Number Mailing Address
Regions Bank: 0077571754 780 Arthur Godfrey Rd.
12. List All Reports Required to be Filed by this Organization with Federal Officials, 8~ the Names, Addresses,
8~ Positions of Such Officials, If Any
Report Title Dates Required to be Filed Name & Position of Official Mailing Address
Form 8871 Within 24 Hrs IRS Ogden, UT
Form 1120-POL Within 5 months of IRS Ogden, UT
fiscal year-end
STATE OF Florida Miami-Dade COUNTY
I, Keith Donner ,certify that the information in this Statement of
Organizati n is complete, true, and correct.
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Signature of Chairperson of Organization Date
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STATE OF FLORIDA OFFICE USE ONLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR POLITICAL COMMITTEES
AND ELECTIONEERING COMMUNICATION
ORGANIZATIONS
(Sections 106.011(1) 8 106.021(1), F.S.)
PLEASE TYPE
CHECK APPROPRIATE BOX:
^/ Original Appointment ^ Deputy Treasurer ^ Reappointment of Treasurer ^ Secondary Depository
1. Committee or Electioneering Communication Organization Name 2. Mailing Address
7525 SW 54th Ct
Floridians for Ethical Government
Telephone (optional) 3. City 4. County 5. State 6. Zip Code
Miami Miami-Dade FL 33143
The following person has been appointed to serve as ^/ Campaign Treasurer ^ Deputy Treasurer for the above named committee.
7. Name of Treasurer or Deputy Treasurer 8. Street Address
Keith Donner 7525 SW 54th Ct
9. City 10. County 11. State 12. Zip Code
Miami Miami-Dade FL 33143
I have designated the following named bank as my ^/ Primary Depository ^ Secondary Depository
13. Bank Name (include account number) 14. Street Address
Regions Bank: 0077571754 780 Arthur Godfrey Rd
15. City 16. County 17. State 18. Zip Code
Miami Beach Miami-Dade FL 33140
19. Name of Chairman 20. Sign ture of Chairman
Keith Donner X ~
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Campaign Treasurer's Acceptance of Appointment
I, Keith Donner , do hereby accept the appointment as
(Please Print or Type)
Campaign Treasurer ^ Deputy Treasurer for the Floridians for Ethical Government
Committee or Organization. As a duly registered voter in Miami-Dade County, Florida, I am
qualified to accept this appointment.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
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10/11 /07
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Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 6 (Rev. 08/04)
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REGISTERED AGENT OFFICE USE ONLY
STATEMENT OF APPOINTMENT
(Section 106.022, F.S.)
(Please Type)
/~ Original Appointment ^ Change of Appointment
Registered Agent and Office Information
Name Keith Donner Telephone 305-666-1868
street Address 7525 SW 54th Ct
city Miami State F~ Zip Code 33143
Mailing Address 7525 SW 54th Ct
City Miami State FL Zip Code 33143
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 Division of Elections.
~~-~ %~ ~ ~,,~.,__.~~ 10/11 /07
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Signature of Registered 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
Floridians for Ethical Government
Street Address 7525 SW 54th Ct Telephone 305-666-1868
City Miami State FL Zip Code 33143
Committee or organization is registered with:
^~ Division of Elections ^ County ^ City
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Signature of Chairperson
Keith Donner 10/11 /07
Print Name of Chairperson Date
Form DS-DE 41 (revised 12/05)