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STATEMENT OF ORGANIZATION
OF POLITICAL COMMITTEE
{PLEASE TYPE)
1. Full Name of Committee Telephone
Proven Leadership for Miami-Dade County PC 305-477-6401
Malling Address (include city, state and zip code)
10200 NW 25th Street #201 Miami Florida 33172
Street Address (include city. state and zip code}
10200 NW 25th Street #201 Miami Florida 33172
2. Affiliated or Connected Organi ludes other committees of continuous existence and political
committees)
‘Name of Affiliated or
Connected Organization Mailing Address Relationship
Floridians for Responsible | 1481 NW 22nd Street Miami Florida 33142
Solutions
‘and Jurisdiction of the Committee
‘Supports statewide and multi county candidates, with an emphasis on Miami-Dade County.
‘4. Nature of Organization or Organization’s Special Interest (e.g., medical, legal, education, etc.)
Poltical
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
Nancy L. Brown 7700 N Kendall Drive #407 Treasurer
Miami F133156
DS-DE 5 (Rev. 06/11) ~ Rule 18-2.017 (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}
Fulvane | Mating Aaaess Commtes Teo Postion
Yesenia Collazo 10200 NW 25th Street #201 Miami Chairperson
Florida 33172
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
Alex Diaz de la Portilla | 1481 NW22 Steet Miami Flodda | Miami-Dade County
| 33142 ‘Commission District §
Other Candidates TBD | TBD TBD
8. List Any Issues this Committee is Supporting: 3p
List Any Issues this Committee is Opposing: 7.
9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party
NIA
10. In the Event of Dissolution, What Disposition will be Made of Residual Funds?
Retumed to contributor/ donate to charity or appropriate committees or otherwise as permitted by law.
11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds
Name of Bank or Depository & Account Number Mailing Address
‘Suntrust Bank 201 Alhambra Circle
Coral Gables Florida 33134
12. List all Reports Required to be Filed by this Committee with Federal Officiats and the Names, Addresses.
and Positions of Such Officials, If Any
Report Title Dates Required to be Filed | Name & Position of Official Mailing Address.
‘As required by law ‘As required by law. As required by law.
state or Florida Miami Dade COUNTY
, Yesenia Collazo certity thatthe information inthis Statement of
Organization is complete. true and correct
May 9, 2018
Date
DS-DE 6 (Rev. 06/11) Rule 15-2017 page= my
1BEAY 10 PHU: 20
: TIONS
"abhi te STATE
HAND DELIVERY .
May 9, 2018
Department of Elections
Tallahassee Florida, 32309
RE!
mended Statement of Organization of Political Committee for Proven leadership for
mi-Dade County PC
Dear Gentlemen:
Attached, is an Amended Statement of Organization of Political Committee for Proven
leadership for Miami-Dade County PC, per your instruction
Thank you.
Yesenia Callao.
