DS-DE 5 Save Miami Beach PFICE USE ONLY
STATEMENT OF O ANIZATION
OF POLITICAL COMMITTEE =r -
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(PLEASE TYPE) 2G15 JUN 2 2 . 2: 22
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1. Full Name of Committee Telephone
Save Mlami Beach 786-252-6918
Mailing Address(include city, state and zip code)
16610 SW 82nd Court, Miami, FL 33157
Street Address(include city, state and zip code)
Same
2.Affiliated or Connected Organizations(includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization Mailing Address Relationship
•
None
•
3.Area, Scope and Jurisdiction of the Committee
Civic engagment and issues in Miami Beach, Florida
4. Nature of Organization or Organization's Special Interest(e.g., medical, legal,education,etc.)
Education .
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
Stephen Cody 16610 SW 82nd Court, Miami, FL 33157 Chair
DS-DE 5(Rev.06/11)—Rule 1S-2.017 (continued on reverse side)
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6. List by Name, Address and Position,Other Principal Officers, Including Officers and Members of the
Finance Committee, If Any(include chairman's name)
Full Name Mailing Address Committee Title or Position
None
7. List by Name,Address, Office Sought and Party Affiliation Each Candidate or Other Individual that this
Committee is Supporting (if none, please indicate)
Full Name Mailing Address Office Sought Party
None
8. List Any Issues this Committee is Supporting:Ethics in City Government
List Any Issues this Committee is Opposing:
9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party
10. In the Event of Dissolution,What Disposition will be Made of Residual Funds?
11. List all Banks, Safety Deposit Boxes,or Other Depositories Used for Committee Funds
Name of Bank or Depository &Account Number Mailing Address
US. Century Bank 468 NW 27th Avenue
Account # 1162001250 Miami, Fl. 33125
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 Title Dates Required to be Filed Name& Position of Official Mailing Address
None
STATE OF Florida Miami-Dade COUNTY
I, Stephen Cody , certify that the information in this Statement of
Organization is complete, true and correct.
62 ( Q
l!nature of Chairman of Poll ' al Committee Date
DS-DE 5(Rev.06/11)-Rule 1S-2.017 page 2
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