DS-DE 5 Save Miami Beach 2016 OFFICE USE ONLY
STATEMENT OF ORGANIZATION
OF POLITICAL COMMITTEE
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(PLEASE TYPE) 2E6 MAR -9 Pfl 14: 36
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1.Full Name of Committee Telephone
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Mailing Address(include city,state and zip code)
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Street Address(include city,state and zip code)
. Sa yin e,
2.Affiliated or Connected Organizations(includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization Mailing Address Relationship
riew._...
3.Area,Scope and Jurisdiction of the Committee
Pi 1 i (AA\C-wN'i 1$1 e) ,-CA-
4.Nature of Organization or Organizatio 's Special Interest(e.g.,medical, legal,education,etc.)
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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
rIA s'e"—^i 87-4.., le t).331301 iti—riA.
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DS-DE 5(Rev.06/11)—Rule 1S-2.017 (continued on reverse side)
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
Da.""Wil at-So 0 CI rvk -3 ap-t-v-e_r-1-
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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
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8.List Any Issues this Committee is Supporting:C� >''1;`�-• 1CSP,� ti p -h 4►5'fa!' t,Art
List Any Issues this Committee is Opposing: f) -- _�4
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?
fruA —to C, ",,r-i k-fps l,,, 5 t.,-.\, (I2 C cS2-c-,S.) Or ,6k3 0
11. List all Banks,Safety Deposit Boxes,or Other Depositories Used for Committee Funds
Name of Bank or/Depository&Account Number Mailing Address
CN .!► --1 c o o - -i`' 'ia i'�"�'' ( ,�
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
STATE OF ' a!`9t r' l4 ''-�`':'-`J COUNTY
f ,certify that the information in this Statement of
Organization is complete,true and correct.
X 1 , 1 -.S.........I .._ /4'�iIIMPANI -I`r A .Aillt.
.''Signature of Chairman of Political Committee Date
DS-DE 5(Rev.06/11)—Rule 1S-2.017 page 2
1