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HomeMy WebLinkAboutCommittee for Responsive Government1215 Indian River Dr. Sebastian, Fl. 3295$ January 9, 2009 C.... :~ Qffice of the Supervisor of Elections ~ 4375 43rd Avenue N Vero Beach, Fl. 32967 ~, }.- r-r Termination Report for `Committee for Responsive Government' : c°x~ This is your notification that all funds collected for use in the August and November 2008 elections have been distributed and all bills paid. Thank you for your past assistance. Sincerely, Ruth Sullivan, Treasurer "~7 C. "'T9 ~'-~ n "_ ~~'~::,- o- -„ ~., ~m ._-, ~ ~ .- -C G~ r f ~ --i rn =-' cc: Sally Maio Sebastian City Clerk WAIVER 4f REP4RT (Section 1t~6.t17(7j, F.8.) (PLEASE. TYPE] o~IC~ >~E i~Y ,.._. Committee for Responsive Government ' Cartdid~e's Nenoie (Last, Sul+lx, Frost, Middle) lderrtifi~on Ntmt~ber {Assigned by l7i+ASion OER Politicatl Committee, CCE or Party .Name of Elections) 1215 Indian River Dr. A (Numb+ar-and 9ti~eet) Offs'e Sough ~ Dom. Cirrxaitcar Sebastian, F1. 32958 LPN) City State Ztp Code o Carle ~ ~ of C ~ boot ~ addnese has dsen9ed a~iae Last 0 Polib~ Committee ~ ~ Exec~ve Corrrmittee Q Check here if PC or CCE has D1S@AMDE.O anal w~ no Longer Ise reports. TYPE OF REPORT ( ~-t~tarlat! Doxl ^ , a 32nd day prior ~ 4138- day prior ^ ApnN O pith day prig ^ 32nd da~- prior ~ ~-roN ~oRT ~ ~ ~ 4th day prior ^ lath dey prig' sPEC:uu. ELECTION D October ©4th lair prior NOTIFICATION OF NO ACTNRY ~ CAMPAK3N AC000NT FOR TIC REPORTIMG PERIOD OF 10/31/08 through 2/2/0$ x . ~ SiSnaturo Data st~u-Ttn~s REasRED FOR: c~aidare Car>didate, C~errtpaign Troasurer or Dept~y Trier (s. tOt3.t?!(5), F.S.) Pdificsl Canmfltees Che~rtaA, Caof~pa~i~n Treasurer ar Deputy Ttser' (s:1t)6.07(~. F.S.) CarrrnRtees of Coosirwous Ex4tertce Tree~aur+er (s. 1c)6.04(4)(c), F.S:) Pae'ly Ezeartlrnei C.orarrriaees Treasurer or Ctt~rtr~aur (s. 108.29(2), F.S.) ~ ~ p~~ when: there hoe been no activsjr ~ the acoosrtt (ra funds eocparded or the filing of the rpufred report ~ warred. Ftowever, the fang oilioar must be noted in writing on the prescribed reporting dale that no roport ~ being ~!. cnv ~~ ~BASTL!~ _: - -- HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772} 589-5570 fax November 3, 2008 Ruth Sullivan Committee for Responsive Government 1215 Indian River Drive Sebastian, FL 32958 Dear Mrs. Sullivan: In accordance with Florida Statutes 106.07, following the election a campaign treasurer's termination report (TR) must be filed with me by February 2, 2009. The TR report (blank forms enclosed) will include a summary page showing the amount of your expenditures since 10/31/08 and an equal amount of total contributions and total expenditures for the entire campaign period. It will also include an expenditure page showing all lawful expenditures in accordance with 106.11(5) and 106.141(4) (enclosed). You need not wait until February to submit the TR report. Once your funds are closed out you can bring in the completed form at any time. If you have any questions or if there is anything I can do to assist you, please do not hesitate to contact me at 388-8214. Sinc~re~y, ~ /` {;_ ~~ Sally A. Maio, MMC City Clerk sam Enclosures (2) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMl1IlARY (1) ~,nmmifi+r~a fnr Ragnnnaicrp Cn~rE+rnmPri~ Name (~) 1215 Indian river Dr. Address (number and street) City, State, Zip Code ^ CHECK 1F ADDRESS HAS CHANGED (4) Check appropriate box(es): d'date (office sought): -OFFICE USE ONLY ~. /! ~ ~ ~ .. v ri ., ~~l s ~ `f7 (3)' ID Number. 16 8 ^ Can t ® political Committee ^ CHECK iF PC HAS DISBANDED f Continuous Existence ^ CHECK IF CCE HAS DISBANDED ^ Committee o [~ Party Executive Committee CHECK IF NO OTHER ELECTIONEERING ^ Electioneering Communication ~ COMMt1NICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS To / C Report Type G4 Cover Period: From g / 13 / 08 10 30-_ 08 -- (~ Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary $ 500. Expenditures $ 1 , 018.33 Cash & Checks $ 518.33 loans Transfers to Office Account $ Total Monetary $ ~ n ~ u '~ ~ !n-Kind $ (9) TOTAL Monetary Contributions To Date $ 1,018.33 Total Monetary $ 1 , O 18.3 3 (g) Other Distributions $ - (10) 70TAL Monetary Expenditures To Date $ __ 1,018.33 (11) CERTIFICATION It is a first degree misdemeanor #or any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, co e~ and complete. mined this report and it is true, correct, and complete, (Type name) Q Individual (only for Treasurer ^ peputy Treasurer electioneering commun.} ~~- X ' l '- Signature DS-DE 12 (Rev. 08/04) (Type name) Candidate /l ~ Chairperson (oNy for PC, PTA 8~ 1~ awcsinneerino cAmmun. organization} X CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Committee for Responsive Government (2) LD. Number 168 f31 haver Period ~ / 1 ~ i n R ttrrouah ~ n / ~ n / n u tat Pans ~ of ~ (5) Date (~) Full Name (8) (9) (10) (1 1) (12) (6) Sequence Number (Last, Suffix, Firs#, Middle) Street Address & Ci State, 2i Code Contributor T e Occu ation Contribution T e 1n-kind Descri lion ame~,d~ Amount 1 1 I Sullivan, Ruth I retired loa 450 1 1215 Indian R Sebastian, Fi. 32958 er . ~i8.33 101 23 108 Neglia, Sal T retired the 225. 2 461 Georgia Sebastian, F1. 32958 50. 101 27 108 Gillmor, Richa d ti d 3 744 Kroegel Sebastian, Fl. 32958 I re re the 225 I I r 1 t ,~ ,-~-A - ! I __ ~ _ cr.~ ~- =: _ 1 1 I DS-DE i3 (Rev. t1$/D3) SEE REVERSE FQR INS7RUCT#ONS AMt) Cf}DE VALUES GAMPAtGN TREASURER'S .REPORT - ITEMIZE© EXPENfliTURES (1) Name Commi t-t•Pr~ fc~r Rr~cr~nmi trc C`n ror+++ne.++- (2) LD. Number 1 6fi (3) Cover Period 9_ I _~- ? ! 0 $ through 10 ! 3 0 / D 8 (4) Page 3 of 3 (5) Date ~) Full Name ($) Purpose (9) (10) (11) (s) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a :candidate) Expenditure TYI~ Amendment Amourrt 10 20 O8 Press JOUrnal sleeves the 60 1 PO BOX 9009 Stuart, F1. 34994 . 1 0-8 Stuart Web a ers h 2 1521 S.E. Palm Ct. Stuart, F1. 34994 p p t e 450 10 Sullivan, Ruth Lo$n re a - 3 1215 Indian River Dr. Sebastian, F1. 32958 p y ment & miss expenses the 508.33 c;.. ~-= _: :.~ :. --.: ua-ut ~a lrcev. uiuus~ SEE REVERSE FOR INSTRUCTIONS ANi) CODE VALUES cm~-~ SE~~T~~I HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax October 20, 2008 Ruth Sullivan Committee for Responsive Government 1215 Indian River Drive Sebastian, FL 32958 Dear Mrs. Sullivan: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for the political action committee for the period October 11, 2008 through October 30, 2008 is due in the Office of the City Clerk no later than 5 pm on Friday, October 31, 2008 (G4). No further contributions can be accepted after midnight on Thursday, October 30, 2008. Any report postmarked by the United States Postal Service no later than midnight of the due date, shall be deemed to have been submitted in a timely manner. Please read FS 106.07(2)(a) for further details. Please familiarize yourself at this time as to proper disbursement of remaining campaign funds in accordance with FS 106. A termination report (TR) will be due once all funds are disbursed properly. The TR report submittal deadline is February 2, 2009. If you have any questions, please do not hesitate to contact me at 388-8214 or e- mail me at smaio@cityofsebastian.org. Sinc~ely, l ~~ .\~'jiJl----- Sally A. aio, MMC City Clerk sam !~~ ~A~/~R ~ ~~~~ (Section. i0aarl(7), F.t3.~ Committee for R `` _ ~~ P~1 3 2$ m esponsive Government Candid~a's Nance (l.aSt, Ste, Fit, M~dfe) 4R Politio~ Committee, CCE or Parly Name 1215 Indian Rimier Dr. Ads (Nutt>~ Attd Street) Sebastian F1. 32958 ~Y S`tate ~ Code 1136 ~, 1 /yam ,_` (7~ V~ ~, ~ T ~. v~ c D ~' CHOP t~+oup Nt' r ^ ~ o t~ o ~~~ e o ~~ ~ Ct~itt~aoc#hes ~ ~. Q ~re~~a aM wi no targer>ils ~_ ~~ __ _ . ~~.~ Q ~, ~ .,- ~EtEC'110N~ t7 32nd ~+ p~ c~crurQa{ ex~r_rae+~~ D •r~r, ~r prior ,~ c~ ~, ©~ ^ 1~n, ~-,, prior ^ ~, ~,, ~ .n,iy t7 ,nth ~, t~ }~ 18th dsy piiar N10'PIFICA?10N ~ ~ ~~iVfiYO~AtGN AOCOUNT FOIL Tf~ R~RT~IO Pt~3t00 OF ~ 10/1/08 X 10/17/08 ~~ ova 1._ Ti±~a+ar or Deputy Tre~xer (s.1116.~1T(~, F S.) t~irrnan, Ca~gn Trea~er a Deputy Tt {s.10Q.fl7(5j, F.S.) Ccmmiltres of Laontlnuouo Existence Percy F~oecuthre Coi~ese ~ Treastseror q (s. tt16.2~. F.S.) ~ ~ reporting period when there has teen rw actev~r ~ ~ ac;aocr~t (no furxfs d or the fiWtg of the regtdred report ie waived Fbwever, the tii~g ofii~aer rrs~st be no~6ed in writ~g on the prestxit~ed reporting dai5e that ra sport is being 61ed. Dt3-0E 87 (tier. t-efio3j CfiY OF ~~wIE HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772} 388-8214 phone - (772} 589-5570 fax October 6, 2008 Ruth Sullivan Committee for Responsive Government 1215 Indian River Drive Sebastian, FL 32958 Dear Mrs. Sullivan: In accordance with Florida Statutes Section 106.07, the campaign treasurer's report for your committee for the period September 27, 2008 through October 10, 2008 is due in the Office of the -City Clerk no later than 5 pm on Friday, October 17, 2008. Any report postmarked by the United States Postal Service no later than midnight of the due date, shall be deemed to have been submitted in a timely manner. Please read FS 106.07(2)(a) for further details. If you have any questions, please do not hesitate to contact me at 388-8214 or a-mail me at smaio@cityofsebastian.org. Sincerely, Sally A. Maio, MMC City Clerk iNA1VER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) OFFICE USE ONLY ~" " ~-: r-:a r:s r-a Comm; t.tPP fCL_RP~~nnsivA Government 168 ~~-=: . Candidate's Name (Last, Suffix, First, Middle) Identification Number (Assigned by Division OR Political Committee, CCE or Party Name of Elections) 1215 Indian River Dr. Address (Number and Street) SPY~aGt i an F1 _ ~~A~iR City State Zip Code Office Sought (Include District, Circuit or Group Number) Candidate ~ Committee of Continuous ~ Check box if address has changed since last Existence report. ® Political Committee ~ Party Executive Committee ~ Check here if PC or CCE has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS ^ January ^ April ^ Jury October PRIMARY ELECTION O 32nd day prior ^ 18th day prior ^ 4th day prior GENERAL ELECTION ^ 46th day prior ^ 32nd day prior ^ 18th day prior ^ 4th day prior ^ TERMINATION REPORT ^ SPECIAL ELECTION NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF 9/13/08 through 9/26/08 X ~. , 10/1/08 Signature Date SIGNATURES REQUIRED FOR: Candidates Candidate, Campaign Treasurer or Deputy Treasurer (s. 106A7(5), F.S.) Political Committees Chairman, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Committees of Coninuous Existence Treasurer (s. 106.04(4}(c), F.S.) Party Executive Committees Treasurer or Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS-0E 87 (Rev. 08103) FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY (1~ommittee for Responsive Government OFFIG6USEONLY Name (Z) _x.215 Indian River Dr. t~ ~- ! 5 +~ t i ~~ Address (number and street) Sebastian, F1. 32958 City, State, Zip Code ^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: 168 (4) Check appropriate box(es): ^ Candidate (office sought): Political Committee ^ CHECK 1F PC HAS DISBANDED ^ Committee of Continuous Existence ^ CHECK 1F CCE HAS DISBANDED ^ Party Executive Committee ^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED (5) REPORT IDENTIFIERS Cover Period: From 0 8 / 2 2 / 0 8 To == / 1 "Z / 0 8 Report Type G 1 ®Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (?) EXPENDITURES THIS REPORT Monetary Cash & Checks $ 50 • Expenditures $ 0 Loans ~ Transfers to Office Account $ Total Monetary $ 50 . Total Monetary $ 0 In-Kind $ (8) Other Distributions (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 50. $ 0 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that 1 have examined this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (Type name) Ruth Sullivan (Type name) Al $aldwin ^ Individual (only for ©Treasurer ^ Deputy Treasurer ^ Candidate X Chai rs (onry for PC, PTY 8 e~ ectioneering commun.) I lectio rin ommun. atg tion) x r - ~ Signature Signature DS-DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS (1) Name Committee for Responsive Government (2) I.D. Number168 (31 Cover Period 0 8 / 2 2 / 0 8 through 0 9 / 12 / 0 8 (41 Paae 2 ~f 3 (5) Date (7) Full Name (8) (9) (10) (11) (12) (6) Sequence Number (Last, Suffix, First, Middle) Street Address & Cit ,State, Zi Code Contributor T e Occu ation Contribution T e In-kind Descri tion Amendment Amount 09 I 12 108 Neglia, Sal 1 461 Georgia Sebastian, F1 32958 I retired the $50. / / <~ c' •: s <: DS-DE 13 (Rev. 08!03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT -ITEMIZED EXPENDITURES (1) Name Committee for Resx~onsive Government (2) I.D. Number 168 (3) Cover Period 0 8 / 2 2 / 0 8 through 0 9/ 12 / 0 8 (4) Page 3 of 3 (5) Date (7) Full Name (8) Purpose (9) (10) (11) (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (add office sought if contribution to a candidate) Expenditure TYpe mendment mount NO EXPENDITURES _ .. r~ _~ DS-DE 14 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ~Cf1Y~OF ,~ i.v ^ 5,~ ~~! HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772} 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org September 10, 2008 Ruth Sullivan Committee for Responsive Government 1215 Indian River Drive Sebastian, FL 32958 Dear Ms. Sullivan: In accordance with Florida Statutes Section 106.07, the G-1 (46th day) campaign treasurer's report for your committee for the period July 1, 2008 through September 12, 2008 is due in the Office of the City Clerk by 5 pm on Friday, September 19, 2008. Any report postmarked by the United States Postal Service no later than midnight of the due date, shall be deemed to have been submitted in a timely manner. If you have any questions, please do not hesitate to contact me at 388-8214. Since ly, ~.%~' ~~J Sally A. Maio. City Clerk rn- MMC sam 1HAR ~f REP~t)fiT E 4!06.t1Tt7), F.3.) tp'i~-~ TYPE) ~- OFFiGE ItSE S~N.Y ~' c~ ~; rv f--• .~ - 3 ~-' n O i-- cn o committee fir Responsive Government 158 CRS F3 Car~idabe's Name (Last, Sut~'uc, First, Middle} Ider>)i~cation Number (Asaigr~ed by Division OR Political f:'.anmRFee, CCi: or Party Name of Elecfions) 1215 Indian River Dr. Addfese (Number and ) C?fftce ht (Irx~de D~hict, CirCUit or Group Number) Sebastian, fl. 32958 D Ceurdidata (] Commithsa of Cordinuous ~ Chem boor ~ address f~ ~inae last report. Po~tiCau Cornmittea ^ Party Exea,aye Committee ~ ~ n ~s CC O~SaAwDEn TYPE OF REPORT (Chick Appropriab Box) ^ .January ^ 32nd day Pte' ^ 48th ~y P~ ^ April ^ 18th day prior ^ 32nd day prig ~ IMPORT ^ Juy ~ stn day prior D '1r~h day prior SPECIAL. ELECTION ^ oclober ^ 4th day prior NOTIFICATION OF NO ACTf1i'ITY iN CAMPAKiN ACCOUNT FOR THE REPDRflNG PERIOD OF 08/02/08 ~rp~h 08/21/08 X 08/21/0.8 Sipttatnre Dste S~NATURE8 RECLNRED FOR: Cardidafss Candidate, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Polltltad Cormnnitboes Ctra~marr, C~r>paign Treasurer ar Deputy Treasurer (s.106.07(5j, F.S.) fommlt~es ~ Contlrtuous Existence TrBasur~ (s. 106.04(4)(c),1=.5.) Partlr Erued~live Tr~surer or Chairman. (s. 106.29(2). F.S.) ~ ~y roP~9 f when fltere has been no acduity in tf~e account (no flrrds expanded or received) the fiNng of the requfred report is waived. HovNa~rar; the fi~ng otfioer must be notified in writing on the pnesaibed reporting datie that no report br being filed. D8-DE r!t rev. f18/Q3) WAIVER OF REPORT (Section 106.07(7), F.S.) (PLEASE TYPE) OFFICE USE ONLY C'O~l,/~i i TEc` T--O,e ~Es~vNs~ v~ ~U~J~,p~y,~;~- Candidate's Name (Last, Suffix, First, Middle) Identification Number (Assigned by Division OR Political Committee, CCE or Party Name of Elections) /v~ /S- ZNJ7~~.rJ .~iy~se Dr2. Address (Number and Street) Office Sought (Include District, Circuit or Group Number) City State Zip Code Candidate ~ Committee of Continuous ~ Check box if address has changed since last Existence report. Political Committee ~ Party Executive Committee ~ Check here if PC or CCE has DISBANDED and will no longer file reports. TYPE OF REPORT (Check Appropriate Box) QUARTERLY REPORTS PRIMARY ELECTION GENERAL ELECTION ^ January ^ 32nd day prior ^ 46th day prior ^ April ^ 18th day prior ^ 32nd day prior ^ TERMINATION REPORT Juty ^ 4th day prior ^ 18th day prior ^ SPECIAL ELECTION ^ October ^ 4th day prior NOTIFICATION OF NO ACTIVITY IN CAMPAIGN ACCOUNT FOR THE REPORTING PERIOD OF .TUN. ...~~ through -Tv %tl~ 3 CU X ~_. _ 7 o D~ Signature ate SIGNATURES REQUIRED FOR: Candidates Candidate, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Political Committees Chairman, Campaign Treasurer or Deputy Treasurer (s. 106.07(5), F.S.) Committees of Continuous Existence Treasurer (s. 106.04(4)(c), F.S.) Party Executive Committees Treasurer or Chairman (s. 106.29(2), F.S.) In any reporting period when there has been no activity in the account (no funds expended or received) the filing of the required report is waived. However, the filing officer must be notified in writing on the prescribed reporting date that no report is being filed. DS-0E 87 (Rev. 08/03) OFFI E U APPOINTMENT OF CAMPAIGN TREASURER E ONLY AND DESIGNATION OF CAMPAIGN ,- ,_ DEPOSITORY FOR POLITICAL k COMMITTEES AND ELECTIONEERING "' '"'' ~ h} ~~ ~ ~ .~ _ .. COMMUNICATION ORGANIZATIONS (Sections 106.011(1) and 106.021(1), F.S.) CHECK APPROPRIATE BOX: T ~ D ~ reasurer eputy Reappointment of Treasurer Original Appointment of Treasurer 1. Committee or Organization 2. Account Number 3. Telephone Committee for Responsive Government 2385888 (772 ) 589-8413 4. Name of Treasurer or Deputy Treasurer 5. Email (optional) 6. Telephone (optional) Ruth Sullivan ( ) 7. Mailing Address 1215 Indian River Drive, Sebastian, Fl. 32958 8. Street Address same as above 9. The following bank has been designated as the ~ Primary Depository ~ Secondary Depository 10. Name of Bank 11. Street Address Wachivia Bank NA 1524 US Highway 1, 12. City 13. State 14. Zip Code Sebastian Florida 32958 15. Signatur f Ch a < 16. Name of Chairman (Print or Type) X Al Baldwin Camaaian T surer's Acceptance of Appointment 1, Ruth Sullivan , do hereby accept the appointment as (Please Print or Type) treasurer or deputy treasurer for Committee for Responsive Government (Committee or Organization) UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE. r ~ X ~ June _4, 2008 dl~ ~'ti`v`~ ~ Date Signature of Campaign Treasurer or Deputy Treasurer DS-DE 6 (Rev. 01/08) Print Reset STATEMENT OF ORGANIZATION OFFICE USE ONLY OF POLITICAL COMMITTEE (PLEASE TYPE) 1. Full Name of Committee Telephone Co~nittee for Responsive Government 772/589-8413 Mailing Address (include city, state and zip code) 1215 Indian River Dr., Sebastian, Fl. 32958 Street Address (include city, state and zip code) 1215 Indian River Dr., Sebastian, Fl. 32958 2. Affiliated or Connected Organizations (includes other committees of continuous existence and political committees) Name of Affiliated or Connected Organization Mailing Address Relationship 3. Area, Scope and Jurisdiction of the Committee Sebastian, Fl. and Indian River County 4. Nature of Organization or Organization's Special Interest (e.g., medical, legal, education, etc.) Political 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 Ruth Sullivan 1215 Indian River Dr. Treasurer Sebastian, F;. 32958 DS-DE 5 (Rev. 05/06) (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 Al Baldwin 4740 47th Court, Vero Beach, Fl. Chairman 32967 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 Sal Neglia 461 Georgia , Sebastian, City Councilman NA Richard Gillmo~- 55 74F41RroegeiBAve. City Councilman NA Sebastian, Fl. 32958 8. List Any Issues this Committee is Supporting: Charter Government List Any Issues this Committee is Opposing: 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? Will be donated to the Indian River Neighborhood Association 11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds Name of Bank or Depository & Account Number Mailing Address Wachovia Bank 2385888 1524 US Highway 1, Sebastian, Fl. 3295 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 NA STATE OF Florida Indian River COUNTY I Al Baldwin ,certify that the information in this Statement of Organization is complete, true and correct. ~~. X na of Chairman of Political Commi to