HomeMy WebLinkAboutRegistered Agent - DSDE41REGISTERED AGENT OFFICE USE ONLY
STATEMENT OF APPOINTMENT RECEIVED
(Section 106.022, F.S.)
I accept this appointment and confirm that I am familiar with and accept the obligations of the position as set
forth in Section 106.022, F.S. I also understand that I may resign this appointment by executing a written
statement of resignation and filing it with the applicable filing officer.
Signature of Registered Agent Date
Former Registered Agent and Office Information (for changes only)
Name I Telephone
Street Address
City State Zip Code
Committee or Organization Information
Name of Committee or Organization
Sebastian Voters Aqainst Gilliams and Parris
1Street Address Telephone
491 Thomas Street 661-713-1793
City State Zip Code
Sebastian Florida 32958
Signatu of hairperson
�.�L
Printed Name f Chairperson Date
Form DS -DE 41 (revised 6/11)
MAP t 12020
City of Sebastian
® Original Appointment
❑ Change of Appointment
City C!crk'c office
❑
❑
Change of Mailing Address
Change of Physical Address
Registered Agent and Office Information
Name
Telephone
Michael Goodfellow
772 -
Street Address
City
State
Zip Code
Sebastian
Florida
32958
Mailina Address
City
State
Zip Code
Sebastian
Florida
31958
I accept this appointment and confirm that I am familiar with and accept the obligations of the position as set
forth in Section 106.022, F.S. I also understand that I may resign this appointment by executing a written
statement of resignation and filing it with the applicable filing officer.
Signature of Registered Agent Date
Former Registered Agent and Office Information (for changes only)
Name I Telephone
Street Address
City State Zip Code
Committee or Organization Information
Name of Committee or Organization
Sebastian Voters Aqainst Gilliams and Parris
1Street Address Telephone
491 Thomas Street 661-713-1793
City State Zip Code
Sebastian Florida 32958
Signatu of hairperson
�.�L
Printed Name f Chairperson Date
Form DS -DE 41 (revised 6/11)