DS-DE 103 Floridians for Efficiency in Government ELECTIONEERING COMMUNICATION
STATEMENT OF ORGANIZATION 2010 DEC 22 All 10: 24
(PLEASE TYPE) DIVISION OF ELECTIONS
OFFICE USE ONLY
1. Full Name of Organization Telephone
Floridians for Efficiency in Government 305-989-4901
Mailing Address(include city, state and zip code)
1825 Ponce de Leon Blvd, Suite 146, Coral Gables, FL 33134
Street Address(include city, state and zip code)
Same as above
2.Affiliated or Connected Organizations
Name of Affiliated or Mailing Address Relationship
Connected Organization
N/A N/A N/A
3.Area,Scope and Jurisdiction of the Organization
Support candidates running for State electedpositions in Florida (State Senate, State Representative, etc.)
4. Identify by Name,Address& Position,the Custodian of Books&Accounts for the Organization
Full Name Mailing Address Street Address Title or Position
Joaquin Urqiuola 2121 Ponce de Leon Blvd, Same as mailing Treasurer
11th floor; Coral Gables,
FL 33134
5. This Organization was formed(check applicable box): (Calendar quarters end the last day of March,June,
September,and December.)
❑ 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.08/10)
(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
Benjamin Pollara 49 Majorca Ave,#202; Same as mailing Chairman
Coral Gables, FL 33134
2121 Ponce de Leon Blvd, Same as mailing Treasurer
Joaquin Urquiola 11th floor; Coral Gables, FL
33134
7. In the Event of Dissolution,What Disposition will be Made of the Residual Funds?
Funds will be either returned to contributors at a pro-rata rate or donated to a tax-exempt 501c(3).
8. List All Banks,Safety Deposit Boxes, or Other Depositories Used by this Organization for Electioneering
Communications
Name of Bank or Depository Mailing Address
US Century Bank 3001 Ponce de Leon,#100
Coral Gables, FL 33134
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
N/A N/A N/A N/A
STATE OF Florida Miami-Dade COUNTY
I Benjamin Pollara , certify that the information in this Statement of
Organization is complete, true, and correct.
-------- 12-17-2010
Jam_.
rgr tu e of Top-ranking Principal Officer of Organization Date
Form DS-DE 103(Rev.08!10)—page 2 of 2 Note: If necessary,continuation sheets should be used to complete the form.