Fillable Dsde103 ELECTIONEERING COMMUNICATIONS ORGANIZATION STATEMENT OF ORGANIZATION (Florida Division of Corporations)

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Dsde103 ELECTIONEERING COMMUNICATIONS ORGANIZATION STATEMENT OF ORGANIZATION (Florida Division of Corporations)

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ELECTIONEERING
COMMUNICATIONS ORGANIZATION
STATEMENT OF ORGANIZATION
(PLEASE TYPE)
OFFICE USE ONLY
1. Full Name of Organization
Telephone
Mailing Address (include city, state and zip code)
Street Address (include city, state and zip code)
2. Affiliated or Connected Organizations
Name of Affiliated or
Connected Organization
Mailing Address Relationship
3. Area, Scope and Jurisdiction of the Organization
4. Identify by Name, Address & Position, the Custodian of Books & Accounts for the Organization
Full Name Mailing Address Street Address Title or Position
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. 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
7. In the Event of Dissolution, What Disposition will be Made of the Residual Funds?
8. List All Banks, Safety Deposit Boxes, or Other Depositories Used by this Organization for Electioneering
Communications
Name of Bank or Depository Mailing Address
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
STATE OF _______________________________ ____________________________ COUNTY
I, ____________________________________________________, certify that the information in this Statement of
Organization is complete, true, and correct.
X_________________________________________________ ________________________________
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.
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Dsde103 ELECTIONEERING COMMUNICATIONS ORGANIZATION STATEMENT OF ORGANIZATION (Florida Division of Corporations)

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Completed 30 July 2020

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