DS-DE 133 (eff. 01/2014)
FLORIDA DEPARTMENT OF STATE
DIVISION OF ELECTIONS
VOTING SYSTEM REGISTERED AGENT DESIGNATION
(Section 101.5605, Fla. Stat.)
This form becomes a public record upon its filing.
VOTING SYSTEM FOR WHICH THIS FORM IS BEING SUBMITTED
Reason for designating registered agent -- check applicable box:
Desire to submit voting system for examination by Division of Elections.
(§ 101.5605(3)(a), Fla. Stat.)
Desire to enter into contract for sale or lease of an approved voting system to a county
within Florida.
(§ 101.5605(3)(b), Fla. Stat).
Name of person submitting the voting system for examination or name or person who will enter into
the contract for the sale or lease of an approved voting system to a county in Florida:
Name:
Company:
Mailing Address: Suite:
City: State: ZIP Code:
Telephone Number:
Email:
Signature: Date:
VOTING SYSTEM REGISTERED AGENT IN FLORIDA
Name of Registered Agent:
Mailing Address: Suite:
City: State: Florida Zip Code:
Telephone Number:
Email:
By signing, I agree to be the registered agent for the voting
system designated above.
Submit the form to the Bureau of Voting Systems Certification, Division of Elections,
R.A. Gray Building, Room 316, Tallahassee, FL 32399-0250. Any changes to this form
must also be reported promptly.
