DS-DE 5 For a Better North Bech OFFICE USE ONLY
STATEMENT OF ORGANIZATION ;
OF POLITICAL COMMITTEE ,; =
2015 S _1 _° a'', i 03
(PLEASE TYPE)
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1. Full Name of Committee Telephone
For a Better North Beach (305) 755-5828
Mailing Address (include city, state and zip code)
c/o Jose Felix Diaz
Akerman LLP
1 SE 3rd Avenue,25th Floor
Miami, FL 33155
Street Address (include city, state and zip code)
2. Affiliated or Connected Organizations (includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization Mailing Address Relationship
n/a
3. Area, Scope and Jurisdiction of the Committee
nd municipal ballot issues
4. Nature of Organization or Organization's Special Interest(e.g., medical, legal, education, etc.)
Government
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
Carlos Trueba 1985 NW 88th Court, Suite 101 Treasurer
Miami, FL 33172
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
Jose Felix Diaz Akerman LLP Chairperson
1 SE 3rd Avenue, 25th Floor
Miami, FL 33131-1714
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: City of Miami Beach referendum related to"Ocean Terrace Overlay District
and others to be determined.
List Any Issues this Committee is Opposing:
To be determined.
9. If this Committee 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 Residual Funds?
Return to contributors Or donate to an IRC Section 527- or 501 (c) org.
11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository&Account Number Mailing Address
City National Bank of Florida 2 S. Biscayne Blvd., #101
Acct. No.: To Be Determined Miami, Fl 33131
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
Form 990 .. Annual . IRS - Ogden, UT
STATE OF Florida Miami-Dade COUNTY
Jose Felix Diaz
—_._ -_ — —-certif__y_that.the_information_in th=sTStatement�of r. ^___._
Organization is complete, true and correct.
X C--. 1"-0--e.,10 - 8.27.2015
ignature of Chairman of Poli cal C)mmittee Date
DS-DE 5(Rev.06/11)—Rule IS-2.017 page 2