Miami Shores United Registered AgentREGISTERED AGENT
OFFICE USE ONLY
STATEMENT OF APPOINTMENT
(Section 106.022, F.S.)
0 1 -27-23P 02 : 29 RC VD
❑✓ Original Appointment ❑ Change of Appointment
❑ Change of Mailing Address ❑ Change of Physical Address
Registered Agent and Office Information
Name
Telephone
�(305)
Andrew C. McIntosh
342-1652
Street Address
434 Grand Concourse
City
State
Zip Code
Miami Shores
Florida
133138
Mailing Address
_
Same as above
City State
Zip Code
I accept this appointment an confirm that I am familiar with and accept the obligations of the position as set
forth in Secti 106.022, F�. I also understand that I may resign this appointment by executing a
n)
written
statement r sr atio �n fi It with the applicable filing officer.
r .. _
January 26, 2023
Signature of Registered Agent
Date
Former Registered Agent and Office Information (for changes only)
Name
Telephone
Street Address
City
State
Zip Code
Committee or Organization Information
Name of Committee or Organization
MIAMI SHORES UNITED, INC.
Street Address
Telephone
434 Grand Concourse
(305) 342-1652
City State
Zip Code
Miami Shores Florida
�33138
Signature of Chairperson
Andrew C. McIntosh
January 26, 2023
Printed Name of Chairperson
Date
Form DS-DE 41 (revised 6/11)