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DS-DE 103 Miami-Dade Preservation and Planning Action Group, Inc. C) _ cry a ELECTIONEERING ... �3 a T COMMUNICATIONS ORGANIZATION 0 STATEMENT OF ORGANIZATION OD (PLEASE TYPE) OFFICE USE ONLY 1. Full Name of Organization Miami-Dade Preservation and Planning Action Telephone(305) Group, Inc. 532-0500 Mailing Address (include city, state and zip code) 19 W. Flagler Street, Suite 402, Miami, Florida 33130 Street Address(include city, state and zip code) 19 W. Flagler Street, Suite 402, Miami, Florida 33130 2. Affiliated or Connected Organizations Name of Affiliated or Mailing Address Relationship Connected Organization None 3. Area, Scope and Jurisdiction of the Organization To educate the general public and public officials about proposed projects and their impact on quality of life issues and neighborhood interests,make presentations before government entities,initiate advertising and public relation campaigns to advocate for neighborhood preservation,historic preservation,and quality of life issues as well as introduce issues related to anticipated consequences of development and construction projects into government policy making. 4. Identify by Name, Address& Position,the Custodian of Books&Accounts for the Organization Full Name Mailing Address Street Address Title or Position Kent Harrison Robbins 19 W. Flagler Street, 19 W. Flagler Street, Treasurer Suite 402, Miami, Suite 402, Miami, Florida 33130 Florida 33130 5. This Organization was formed(check applicable box): (Calendar quarters end the last day of March,June, September, and December.) IIII As a newly created organization during the current calendar quarter. From an organization existing prior to the current calendar quarter. Form DS-DE 103(Rev.06/11)—Rule 1S-2.017 (continued on reverse) 6. List By Name, Mailing and Street Address, & Position, Other Principal Officers, including the treasurer and deputy treasurer, if any. Include the top-ranking officer's(e.g., chairperson) name and information. Full Name Mailing Address Street Address Title or Position Christina Labuzetta 311 Lincoln Rd, Suite 305, 311 Lincoln Rd,Ste 305, President C1P-STl Nl9 a(AMINO Miami Beach, Florida 33139 Miami Beach, Florida 33139 VeCODPCES•can, Stuart Smith 100 South Pointe Dr, Apt 3304, 100 South Pointe Dr,Apt Secretary 33139 Ssm ttt-\&SMtr�-1Sr�� Miami Beach, Florida 33139 3304, Miami Beach, Florida Kent Harrison Robbins 19 W. Flagler Street, Suite 19 W. Flagler Street,Suite Treasurer K;rtle. W (- -L w CES 402, Miami, Florida 33130 402, Miami, Florida 33130 • 7. In the Event of Dissolution,What Disposition will be Made of the Residual Funds? • All funds shall be distributed consistent with the 501c4 purposes prior to dissolution. 8. List All Banks, Safety Deposit Boxes,or Other Depositories Used by this Organization for Electioneering Communications Name of Bank or Depository Mailing Address Regions Bank 1601 Washington Avenue • Miami Beach, Florida 33139 9. List All Reports Required to be Filed by this Organization with Federal Officials, &the Names, Addresses, & 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 Christina Labuzetta , certify that the information in this Statement of Organization is complete, true, and correct. X ;e ms, A [ o ( ( ct ( / - Signature of Top-ranking Principal Officer of Organization Date Form DS-DE 103(Rev.06/11)-Rule 1S-2.017-page 2 of 2 If necessary,use continuation sheets to complete the form.