Utilities - Palm Beach

Transcription

STATEMENT OF ORGANIZATION
OF POLITICAL COMMITTEE
OFFICE USE ONLY
REIEIUED
2rl1E FEB 21 11134 TtlH
1. Full Name of Committee
Telephone
Keep The Lights On Palm Beach
561-588-8021
l\ilailing Address (include city, state and zip code)
2784 South Ocean Blvd., 401S, Palm Beach, FL 33480
Street Address (include city, state and zip code)
2784 South Ocean Blvd., 401S, Palm Beach FL 33480
2. Affiliated or Connected Organizations (includes other committees of continuous existence and political
committees)
Name of Affiliated or
Connected Organization
Mailing Address
3. Area, Scope and Jurisdiction of the Committee
Support the Town of Palm Beach Undergrounding lssue
4. Nature of Organization or Organization's Special lnterest (e.9., medical, legal, education, etc.)
Utilities
5. ldentify by Name, Address and Position, the Custodian of Books and Accounts (include treasurer's name)
E. Llwyd Ecclestone
2784 South Ocean Blvd.,401S, Palm
Beach FL 33480
Gerald Frank
2784 South Ocean Blvd.,401S, Palm
Beach FL 33480
DS-DE 5 (Rev.06/11)- Rule 15-2.017
(continued on reverse side)
6. List by Name, Address and Position, Other Principal Officers, lncluding Officers and Members of the
Finance Committee, lf Any (include chairman's name)
Full Name
Mailing Address
Committee Title or Position
E. Llwyd Ecclestone
2784 South Ocean Blvd., 401S, Palm
Beach FL 33480
Gerald Frank
2784 South Ocean Blvd., 401S, Palm
Beach FL 33480
Chairman
Treasurer
7. List by Name, Address, Office Sought and Party Affiliation Each Candidate or Other lndividual that this
Committee is Supporting (if none, please indicate)
FullName
Office Sought
Mailing Address
Party
NONE
8. List Any lssues this Committee is Supporting:
List Any lssues this Committee is Opposing:
Town of palm Beach Undergrounding lssue
NONE
9. lf this Committee is Supporting the Entire Ticket of a Party, Give Name of Party
NONE
10. ln the Event of Dissolution, What Disposition
will be Made of Residual Funds?
Donate to a 501 (c) organization
11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository & Account Number
Wells Fargo
Account No.: TBD
Mailing Address
255 S. County Road, Palm Beach, FL 33480
12. List all Reports Required to be Filed by this Committee with Federal Officials and the Names, Addresses
and Positions of Such Officials, lf Any
Report Title
Dates Required to be Filed
Form 990
srArE oF
Annual
r, E. Llwyd Ecclestone
,
Mailing Address
Ogden, UT
IRS
Palm Beach
Florida
Organization is
Name & Position of Official
COUNTY
, certify that the information in this Statement of
true and correct.
x
,,
\rz\tu
\
DS-DE 5 (Rev. 06/11)
-
Rule l5-2.017
Date
page2
OFFICE USE ONLY
REGISTERED AGENT
STATEMENT OF APPOINTMENT
(Section 1 06.022, F.S.)
RETEIUES
:rllE
El
E
originat
Appointment E
an.nn" of Mailing Address
cn"ng"
n
FEE':3 11134 Ttli'{ i
of Appointment
anrnn" of Physical Address
Registered Agent and Office lnformation
Name
Telephone
Gerald Frank
561-588-8021
Street Address
2784 South Ocean Blvd.. 401S
City
State
Zip Code
Palm Beach
FL
33480
Mailing Address
2784 South Ocean Blvd., 401S
City
State
Zip Code
Palm Beach
FL
33480
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
statemgnt of resignation qaf filing it with the applicable filing officer.
of Registered Agent
'z/ez,' I
Date
/
/
Former Registered Agent and Office lnformation (for changes only)
Telephone
Name
Street Address
Zip Code
State
City
Committee or Organization Information
Name of Committee or Organization
Keep The Liqhts On Palm Beach
Street Address
Telephone
2784 South Ocean Blvd., 401S
561 -5BB-8021
City
State
Zip Code
Palm Beach
FL
33480
E. Llwyd Ecclestone
Printed Name of Chairperson
Form DS-DE 41 (revised 6/'11)
Drt"
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n-r+FEl
fa I-Li-
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APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR
POLITICAL COMMITTEES
(Sections r06.011(1) and 106.021(1), F.S.)
OFFICE USE ONLY
CHECK APPROPRIATE BOX:
E
tr
original Appointment of Treasurer
tr
tment of Treasurer
Deputy Treasurer
2. Telephone
1. Committee or Organization
(561
a. Emai(ytional)
3. Name of Treasurer or Deputy Treasurer
Gerald Frank
) 5BB-8021
5. Telephone (optional)
-
(561 ) 588-8021
[email protected]
6. Mailing Address
2784 South Ocean Blvd.,401 S, Palm Beach FL 33480
7. Street Address
2784 South Ocean Blvd.,401 S, Palm Beach FL 33480
8. The following bank has been designated as
the tr
Primary
Depository
t]
Secondary Depository
10. Street Address
9. Name of Bank
Wells Fargo
255 S. County Road
11. City
13. Zip Code
12. State
Palm Beach
33480
FL
15. Name of Chairman (Print or Type)
14. Signature
x
E. Llwyd Ecclestone
Campaiqn Treasurer's Acceptance of Appointment
Gerald Frank
,
do hereby accept the appointment as
(Please Print or Type)
treasurer or deputy treasurer for
(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.
Treasurer or Deputy Treasurer
DS-DE 6 (Rev. 7/'t0)
RETEIUE}
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR
POLITICAL COMMITTEES
:BLE
FEE 2E 11r:{+ THH
(Sections 106.011(1) and'106.021(1), F.S.)
OFFICE USE ONLY
CHECK APPROPRIATE BOX:
tr
n
original Appointment of Treasurer
I
Reappoin tment of Treasurer
1. Committee or Organization
Deputy Treasurer
2. Telephone
(561
3. Name of Treasurer or Deputy
Treasurer
) 588-8021
5. Telephone (optional)
4. Email (optional)
(561 ) 588-8021
E. Llwyd Ecclestone
6. Mailing Address
2784 South Ocean Blvd ., 401S, Palm Beach FL 33480
7. Street Address
2784 South Ocean Blvd .,
8. The following bank has been designated as
401
the E
9. Name of Bank
Primary
Depository
tr
Secondary Depository
10. Street Address
Wells Fargo
255 S. County Road
11. City
13. Zip Code
12. State
Palm Beach
x
33480
FL
^h/,urh,
14. Signature
'
E.
S, Palm Beach FL 33480
15. Name of Chairman (Print or Type)
E. Llwyd Ecclestone
Cambaiqn Treasurer's Acceptance of Appointment
Llwyd Ecclestone
,
do hereby accept the appointment as
(Please Print or Type)
treasurer or deputy treasurer for
(Committee or Organization)
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
)
.L /LL / z'ot I
,
Date
DS-DE 6 (Rev.7/10)
re of Campaign Treasurer or Deputy Treasurer
rl
trtr
t/

Utilities - Palm Beach

Transcription

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