Loading...
Clearwater Matters IncCAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY OFFICE USE ONLY RECEIVED NOV 13 2017 OFFICIAL RECORDS AND Name (2) 625 Court Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code ❑ Check here if address has chan ed g (3) (4) Check appropriate box(es): ❑ Candidate Office Sought: LEGISLATIVE SRVCS DEPT. ID Number: ✓ Political Committee (PC) here if PC or ECO has disbanded here if PTY has disbanded here if no other IE or EC reports will be filed ❑ Electioneering Communications Org. (ECO) 1 Check ❑ Party Executive Committee (PTY) ❑ Check ❑ Independent Expenditure (IE) (also covers an ❑ Check individual making electioneering communications) (5) Report Identifiers Cover Period: From 11 / 3 / 17 To 11 / 13 / 17 Report Type: TR Election Report ✓ Original ❑ Amendment ❑ Special (6) Contributions This Report Cash & Checks $ , , 0 . 00 (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , , 0 . 00 Loans $ , , • to $. Total Monetary $ • $. In-Kind $ , , • (8) $. Other Distributions (9) TOTAL Monetary Contributions To Date $ , 17 , 850 , 00 (10) TOTAL Monetary Expenditures To Date $ , 17 , 850 . 00 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Jay E. Pol.Iaze to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, Jr. • Individual (only for IE 13 Tr- : surer ■ Deputy Treasurer 0 Candidate X GI Chairperson (only for PC and PTY) or electioneering comm.)/)) X .. /. ir►�i% � /S. ikr✓ 1 - ., Signatur_ / Y Signature D -DE 12 (Re 1/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc.s SUMMARY 0 OFFICIAL RECORDS LEGISLATIVE LY ���7 AND SRVCS DEPT. Names (2) 625 Court Street, Suite 200lQi� Address (number and street) Clearwater, FL 33756 City, State, Zip Code ❑ Check here if address has changed (3) (4) Check appropriate box(es): ❑ Candidate Office Sought: ID Number: 1 Political Committee (PC) ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed ❑ Electioneering Communications Org. (ECO) ❑ Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) (5) Report Identifiers Cover Period: From 10 / 20 / 17 To 11 / 2 / 17 Report Type: R-2 Election Report 1 Original ❑ Amendment ❑ Special (6) Contributions This Report Cash & Checks $ , 4 , 775 . 00 (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , , 050 • on Loans $ • __ to $. Total Monetary $ • $. In -Kind $ , (8) $• Other Distributions (9) TOTAL Monetary Contributions To Date $ , 17 , 850 . 00 (10) TOTAL Monetary Expenditures To Date $ , 17 , 850 • 00 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Jay E. Polglaze to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, Jr. ■ Individual (only for IE ri Tre- = • -r • Deputy Treasurer ■ Candidate O Chairperson (only for PC and PTY) .,. or electioneering comm.) X f ..7 X `e_i /, it igna re Signature g e DS -DE 12 v. 11113) SEE REVERSE FOR INSTRUCTIONS (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. (3) Cover Period (2) I.D. Number 10 / 20 17 11 / 2 / 17 1 of 2 (4) Page / through DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number Brian Aungst, Jr. 10 31 17 1683 Midnight Pass Way / / Clearwater, FL 33765 1 I Attorney CHE $500 Dan Shouvlin 111 / 17 / 425 Buttonwood Ln Largo, FL 33770 2 I Food Service CHE $1000 Jay E. Polglaze 11 1 17 522 Richards Ave. / / © Clearwater, FL 33755 3 I Exec. Dir. CHE $501.20 Zev Buffman 111 17 207 South Gulf Dr. / / Crystal Beach, FL 4 34681 I CEO CHE $500 11 1 17 Correline Consultants, LLC / / 600 Cleveland Street, Suite 202 B CHE $500 5 Clearwater, FL 33755 Seth Taylor 11 1 17 390 5th Street N. / / Safety Harbor, FL 6 34695 I Entrepreneur CHE $100 Mid Atlantic Finance 11 1 17 4592 Ulmerton Rd / / Clearwater, FL 33762 7 B CHE $1173.80 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. (1) Name 10 20 17 11 / through (3) Cover Period / / (2) I.D. Number 2/ 17 (4) Page 2 of 2 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number 11 / 1 / 17 Becker Holdings, INC 4890 Cross Pointe Dr Oldsmar, FL 34677 B CHE $500 8 / / / / / / / / / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater Matters, Inc. (2) I.D. Number (3) Cover Period 10 / 20 / 17 through 11 / 2 / 17 (4) Page 1 of 1 DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (71) Amount (6) Sequence Number 11 / 1 / 17 Data Targeting, Inc. 6211 NW 132nd Street Gainesville, FL 32653 Direct Mail ECC $5,900 1 11 2 / / 17 City of Clearwater 112 S. Osceola Ave. Clearwater, FL 33756 Filing Fee IEI $150 / / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY a F -ACE USE ONr:Y L Name (2) 625 Court Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code ❑ Check here if address has changed (3) (4) Check appropriate box(es): ❑ Candidate Office Sought: ID Number: ✓ Political Committee (PC) ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed ❑ Electioneering Communications Org. (ECO) II Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) (5) Report Identifiers Cover Period: From 10 / 1 / 17 To 10 / 19 / 17 Report Type: M-10 Election Report 1 Original ❑ Amendment ❑ Special (6) Contributions This Report Cash & Checks $ , 1 , 500. 00 (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , 11 , 800 . 00 Loans $, , to $ , , Total Monetary $, , • $ . , In -Kind $, , • (8) Other Distributions $. (9) TOTAL Monetary Contributions To Date $ , 13 , 075 . 00 (10) TOTAL Monetary Expenditures To Date $ , 11 , 800 . 00 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Jay E. Polglaze to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, Jr. • Individual (only for IF 0 Treasurer ■ Deputy Treasurer 0 Candidate x GI Chairperson (only for PC and PTY) or electioneering comb.) XX :-7 Signa - Signature DS -DE 12 (Re 11/13) SEE REVERSE FOR INSTRUCTIONS (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. 10 (3) Cover Period / 1 17 / 10 through (2) I.D. Number 2017 / / (4) Page 1 of DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number The Tropics Boat Tours 10 3 17 615 Pinellas St. Unit / / 2 Clearwater, FL 33756 1 E CHE $250 David Lillesand 106 / / 17 331 Cleveland St, Suite 1105 2 Clearwater, FL 33755 I Attorney CHE $100 William C. Jonson 106 / / 17 ill 2694 Redford Court W. Clearwater, FL 33761 3 I City Council CHE $500 Brian J. Aungst, Sr. 10/ 7 17 2633 Brattle Ln. / Clearwater, FL 33761 4 I Govt. Affair CHE $300 P l a c e M a k e r 10 / 7 / 17 Design S t u d i o, LLC 5 3000 Gulf to Bay Blvd g $350 Suite 402 Clearwater Florida 33759 / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater Matters, Inc. (2) I.D. Number (3) Cover Period 10 / 1 / 17 through 10 19 / 17 (4) Page 1 of 1 DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (70) Amendment (11) Amount (6) Sequence Number 10 / 3 / 17 Data Targeting, Inc. 6211 NW 132nd Street Gainesville, FL 32653 Direct Mail ECC $5,900 1 1012 / 17 / Data Targeting, Inc. 6211 NW 132nd Street Gainesville, FL 32653 Direct Mail ECC $5,900 / / / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY OFFICE USE ONLY 7 f" • '-,,, ',::T 0 6 201-J Name (2) 625 Court Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code Check here if address has changed (3) (4) Check appropriate box(es): El Candidate Office Sought: LEGISL/4l ID Num,iL ,,..., ber: i Political Committee (PC) El Check here if PC or ECO has disbanded El Check here if PTY has disbanded El Check here if no other IE or EC reports will be filed Electioneering Communications Org. (ECO) El Party Executive Committee (PTY) Independent Expenditure (IE) (also covers an individual making electioneering communications) (5) Report Identifiers Cover Period: From 9 / 1 / 17 To 9 / 30 / 17 Report Type: M-9 Election Report 1 Original Amendment D Special (6) Contributions This Report Cash & Checks $ , 11, 575 .00 (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , , 0 . 00 Loans $ , , • to $ . Total Monetary $ , , • $ In -Kind $ , , • (8) Other Distributions $ , , . (9) TOTAL Monetary Contributions To Date $ , 11 , 575 . 00 (10) TOTAL Monetary Expenditures To Date $ , , 0 . 00 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Jay E. Polgl. - to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, Jr. • Individual (only for IE 1:1 Treasu r El Dep Treasurer IN Candidate GI Chairperson (only for PC and PTY) or electioneering comm.) X d_°°: C. 41‘..-411111111/6.-4.1 X _Ilk ignature OF Signature DS -DE 12 (Revy/13) SEE REVERSE FOR INSTRUCTIONS (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. 9 (3) Cover Period / 1 17 9 through / / 30 17 (2) I.D. Number 1 3 (4) Page of DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number Aungst, Jr., Brian J. 9 5 17 1683 Midnight Pass Way / / Clearwater, 33765 1 I Attorney CHE $500 Clearwater Downtown 9/ 5 17 Partnership, Inc. / 600 Cleveland Street 2 Suite 450 B CHE $2,500 Clearwater, FL 33755 CLEARPAC, INC. 95 / 17 / 600 Cleveland Street Suite 200 3 Clearwater, FL 33755 F CHE $1,000 Anderwood Properties, 9/ 5 17 LLC / 2604 Tampa East Blvd, Suite H B CHE $1,000 4 Tampa, FL 33619 Dame, Frank L. 9 5 17 407 Leeward Island / / Clearwater, FL 33767 5 I COO CHE $200 Jeffrey Kelby 9 / 6 17 / 331 Cleveland Street, Apt 1505 6 Clearwater, FL 33755 I Retired CHE $100 Craig Rubright 9 / 6 17 / 331 Cleveland Street, Apt 1204 7 Clearwater, FL 33755 I CFO CHE $250 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. 9 (3) Cover Period / 1 / 17 through 9 (2) I.D. Number / 30 / 17 (4) Page 2 of 3 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number Michael Eldridge 9 6 17 Zonna M. Crayne / / 331 Cleveland Street, 8 Suite 1804 Clearwater, FL 33755 I Sales CHE $250 Joseph R. Corvino 9/ 6 17 Joyce M. Corvino / 331 Cleveland Street, Apt 1702 I Com. Rel. CHE $100 9 Clearwater, FL 33755 Michael W. Marsh 9/ 6 17 Stacy L. Marsh / 331 Cleveland Street, Suite 504 Clearwater, FL 33755 I Medical CHE $100 10 P. Waskie 9/ 6 / 17 331 Cleveland Streert, Apt 205 11 Clearwater, FL 33755 I Retired CAS $25 Jack Mortimer 9 18 17 Janet L. Mortimer / / 331 Cleveland Street, 12 Apt 805 I Media CHE $250 Clearwater, FL 33755 9 18 17 drew Peters / / 1401 West Bay Drive Largo FL 33770 13 I Physician CHE $250 Maylisa I. Yofan 9 18 17 Abraham Yofan 1 / 331 Cleveland Street, Apt. 1006 I Retired CHE $100 14 Clearwater, FL 33755 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. 9 (3) Cover Period / 1 17 / 9 through (2) I.D. Number 3017 / / 3 3 (4) Page of DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In-kind Description (11) Amendment (12) Amount (6) Sequence Number Thomas Petersen, Sr. 9 / 18 / 17 331 Cleveland Street, Apt 904 15 Clearwater, FL 33755 I Retired CHE $250 Sally Jensen 9/ 18 17 Craig Jensen / 611 S. Fort Harrison 16 Ave., Apt. 357 Clearwater, FL 33756 I Retired CHE $200 Matt Crum 926 / / 17 Kathleen Crum 2125 Scarlett Oaks St. 17 Clearwater, FL 33765 1 president CHE $250 David J. Lillesand 9/ 26 17 Diane V. Lillesand / 331 Cleveland Street 18 Suite 1105 Clearwater, FL 33755 I Attorney CHE $250 Zev Huffman 9 27 17 207 South Gulf Dr. / / Crystal Beach, FL 19 34681 I CEO CHE $1,000 9 27 17 Correline Consultants, LLC / / 600 Cleveland Street, Suite 202 B CHE $3,000 20 Clearwater, FL 33755 / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES STATEMENT OF ORGANIZATION OF POLITICAL COMMITTEE (PLEASE TYPE) OFFICE USE ONLY O ICEU S SEP 07 2017 OFFICIAL RECORDS AND LEGISLATIVE 5 .V _ ''::7-1- 1. Full Name of Committee Clearwater Matters, Inc. Telephone (727) 441 -8966 Mailing Address (include city, state and zip code) 625 Court Street, Suite 200, Clearwater, FL 33756 Street Address (include city, state and zip code) 625 Court Street, Suite 200, Clearwater, FL 33756 2. Affiliated or Connected Organizations (includes other committees of continuous existence and political committees) Name of Affiliated or Connected Organization Mailing Address Relationship N/A 3. Area, Scope and Jurisdiction of the Committee City of Clearwater November 7, 2017 Referendum Election 4. Nature of Organization or Organization's Special Interest (e.g., medical, legal, education, etc.) Quality of life, economic development, and commerce 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 Brian J. Aungst, Jr. Jay E. Polglaze 625 Court Street, Suite 200, Clearwater, FL 33756 625 Court Street, Suite 200, Clearwater, FL 33756 President/Chairman Treasurer DS -DE 5 (Rev. 06/11) — Rule 1S -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) Full Name Mailing Address Committee Title or Position N/A 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 N/A 8. List Any Issues this Committee is Supporting: Support Passage of the Imagine Clearwater List Any Issues this Committee is opposing: Referendum on November 7, 2017 9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party N/A 10. In the Event of Dissolution, What Disposition will be Made of Residual Funds? Fund will be disposed of in accordance with applicable law 11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds Name of Bank or Depository & Account Number Mailing Address USAmeribank Account # 500287867 1617 Gulf to Bay Boulevard Clearwater, Florida 33755 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 N/A STATE OF Florida Pinellas COUNTY Brian J. Aungst, Jr. , certify that the information in this Statement of Organization is complete, true X and correct. / ci i 1-7 Signature of Chairman of Political Committee Date DS -DE 5 (Rev. 06/11) — Rule 1S -2.017 page 2 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR POLITICAL COMMITTEES (Sections 106.011(1) and 106.021(1), F.S.) CHECK APPROPRIATE BOX: I RECEIVLD SEP 07 2017 OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEFT. OFFICE USE ONLY ® Original Appointment of Treasurer . Reappointment of Treasurer ■ Deputy Treasurer 1. Committee or Organization Clearwater Matters, Inc. 2. Telephone (727 ) 441 -8966 3. Name of Treasurer or Deputy Treasurer 4. Email (optional) Jay E. Polglaze 5. Telephone (optional) (727 ) 410 -3270 6. Mailing Address 625 Court Street, Suite 200, Clearwater, FL 33756 7. Street Address 625 Court Street, Suite 200, Clearwater, FL 33756 8. The following bank has been designated as the © Primary Depository El Secondary Depository 9. Name of Bank USAmeribank 10. Street Address 1617 Gulf to Bay Boulevard 11. City Clearwater 12. State Florida 13. Zip Code 33755 14. Signature of Chairman X / _,r (#1,1-/ 1 15. Name of Chairman (Print or Type) Brian J. Aungst, Jr. Camnaian Treasurer's Acceptance of Appointment Jay E. Polglaze , do hereby accept the appointment as (Please Print or Type) treasurer or deputy treasurer for Clearwater Matters, Inc. (Committee or Organization) UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING C PAIGN TREASURER'S ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED AR T. E. ( '2/ t X ›' ..0 , Date S natuy6 of Camplalgn Trea.urer or seputy Treasurer DS -DE 6 (Rev. 7/10) REGISTERED AGENT STATEMENT OF APPOINTMENT (Section 106.022, F.S.) OFFICE USE ONLY RECEIVED SEP 07 2017 OFFICIAL RECORDS AK,ID Address ✓ Original Appointment ❑ Change of Appointment ❑ Change of Mailing Address ❑ Change of Physical Registered Agent and Office Information Name Brian J. Aungst, Jr. Telephone (727) 441 -8966 Street Address 625 Court Street, Suite 200 City Clearwater State FL Zip Code 33756 Mailing Address 625 Court Street, Suite 200 City Clearwater State FL Zip Code 33756 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. / ,-,k_. 7 , 1 ' (1 / 41(.1— 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 Clearwater Matters, Inc. Street Address Telephone 625 Court Street, Suite 200 (727) 441 -8966 City Clearwater State Zip Code FL 33756 '--.. ) (-VT Signature of Chairper n R �Z,., 4,4 r. 1111-1(1 Printed Name of Chairperson Date Form DS -DE 41 (revised 6/11) CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY oFFinfq tvz,-1JIYD 1 ,:kR LECIL'-i.Ai`iVE ::a',0,CS DEVI Name (2) 600 Cleveland Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code Check here if address has changed (3) (4) Check appropriate box(es): fl Candidate Office Sought: ID Number: 1 Political Committee (PC) here if PC or ECO has disbanded here if PTY has disbanded here if no other IE or EC reports will be filed LI Electioneering Communications Org. (ECO) I Check Party Executive Committee (PTY) 111 Check • Independent Expenditure (IE) (also covers an GI Check individual making electioneering communications) (5) Report Identifiers Cover Period: From 3 / 11 / 16 To 3 / 18 / 16 Report Type: TR Original LIJ Amendment LI Special Election Report (6) Contributions This Report Cash & Checks $ , , • (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , , 27 . 60 Loans $ , , • to $ . Total Monetary $ , , 0 . 00 $ , , 27 . 60 In-Kind $ , , • (8) $ Other Distributions . (9) TOTAL Monetary Contributions To Date $ , 20 , 027 . 60 (10) TOTAL Monetary Expenditures To Date $ , 20 , 027 . 60 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Brian J. Aungst, Jr. to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, Jr. 0 Individual (only for IE El Treasurer El Deputy Treasurer or electioneering comm.) X /\ 7 , A 0 Candidate El Chairperson (only for PC and PTY) X /3 Signature Signature DS-DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater matters, Inc. (2) I.D. Number (3) Cover Period 3 / 11 / 16 through 3 / 18 / 16 (4) Page 1 of 1 DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (1 0) Amendment (11) Amount (6) Sequence Number 3 /11 / 16 USAMERIBANK 1617 Gulf to Bay Blvd. Clearwater, FL 33765 Banking /Checking fees IEI 27.60 / / / / / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1) CAMPAIGN TREASURER'S REPORT SUMMARY Clearwater Matters, Inc. Name (2) 600 Cleveland Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code ❑ Check here if address has changed (4) Check appropriate box(es): ❑ Candidate Office Sought: 12 RECEIVED MAR r L 6% i li LEG1SL/- Vt S: VC'S DEPT (3) ID Number: Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑ Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed (5) Report Identifiers Cover Period: From 2 / 27 / 16 To 3 / 10 / 16 Report Type: G3 ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks Loans Total Monetary In -Kind $ , 3 , 062. 75 $ 3 , 062.75 (7) Expenditures This Report Monetary Expenditures $ , 10 , 000 . 00 Transfers to Office Account $ Total Monetary $ , 10 , 000. 00 (8) Other Distributions (9) TOTAL Monetary Contributions To Date $ , 20 , 027 , 60 (10) TOTAL Monetary Expenditures To Date $ , 20 , 000 00 (11) Certification It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, correct, and complete: (Type name) Brian J. Aungst, Jr. ❑ Individual (only for IE or electioneering comm.) ❑ Treasurer El Deputy Treasurer (Type name) Brian J. Aungst, Jr. ❑ Candidate LJ Chairperson (only for PC and PTY) X ETA i q_ Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. (1) Name 2 27 16 3 (3) Cover Period / / through (2) I.D. Number / 10 / 16 (4) Page 1 of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number Grant Wood 3 1 16 2934 W. Bayshore / / Court, Tampa, FL 33611 G3 -1 I Real Estate CHE $241.10 Charles Allcott 3 1 16 1502 Citrine Trail, / / Tarpon Springs, FL G3 -2 34689 I Banking CHE $96.35 Lisa Mansell 3 2 16 1301 Amble Lane Unit / / 202, Clearwater, FL G3 -3 33755 I PublicPolicy CHE $250 Daniels Ikajevs 3 2 16 600 Cleveland Street, / / Clearwater, FL 33755 G3 -4 I Real Estate CHE $1,000 Matt Becker 3 2 16 4890 Cross Pointe Dr., / / Oldsmar, Fl 34677 G3 -5 I CEO CHE $192.85 Frank Dame 3 10 it, 407 Leeward Island, / / Clearwater, FL 33767 G3 -6 I C00 CHE $200 3 10 16 Zev Buffman / / P.O. Box 951, Crystal Beach, FL 34681 G3 -7 I CEO CHE $1,000 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. (1) Name 2 27 16 3 (3) Cover Period / / through 10 16 (2) I.D. Number (4) Page 2 of 2 -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code 3 / 10 16 / Brian J. Aungst, Jr. 1683 Midnight Pass Way Clearwater, FL 33765 I Attorney CHE $54.85 G3-8 3 / 10 16 / Zachary Thorn 1455 Grove Street, Clearwater, FL 33755 I GovtAffairs CHE $27.60 G3 -9 / / / / / / / / / / -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater Matters, Inc. (3) Cover Period 2 / 27 / 16 through 3 / 10 / 16 (2) I.D. Number (4) Page 1 of 1 (5) Date (7) Full Name (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (1 0) Amendment (11) Amount (6) Sequence Number (Last, Suffix, First, Middle) Street Address & City, State, Zip Code 3 /1 //16 Data Targeting, Inc. 6211 NW 132nd Street Gainesville, Campaign Mailer IEI $5,000 G3 -1 FL 32653 3 8 16 / / Data Targeting, Inc. 6211 NW 132nd Street Gainesville, FL 32653 Campaign Mailer IEI $3,500 G3 -2 3 / 8 / 16 Poli Solutions Consulting, LLC 9800 - 4th Street N, Suite 200 St. Petersburg, FL 33702 Consulting IEI $1,500 G3 -3 / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES MACFARLANE FERGUSON & MCMULLEN ATTORNEYS AND COUNSELORS AT LAW P.O. BOX 1669 CLEARWATER, FLORIDA 33757 Rosemarie Call, City Clerk 112 S. Osceola Ave. Clearwater FL 33756 C:01.0 Hasler 03/11/2016 US POSTAGE FIRST-CLASS MAIL $00.702 ZIP 33756 011 D11627282 CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY oRKEVED MAR 0 4 2016 OFFICIAL RECORDS AND LEGISLATIVE SkVCS DEPT Name (2) 600 Cleveland Street, Suite 200 Address (number and street) Clearwater, FL 33755 City, State, Zip Code ❑ Check here if address has changed (3) (4) Check appropriate box(es): ❑ Candidate Office Sought: ID Number: ✓ Political Committee (PC) ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed ❑ Electioneering Communications Org. (ECO) ❑ Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) (5) Report Identifiers Cover Period: From 2 / 13 / 16 To 2 / 23 / 16 Report Type: G2 Election Report ✓ Original ❑ Amendment ❑ Special (6) Contributions This Report Cash & Checks $ , 1 , 464. 85 (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , 10 , 000 . 00 Loans $ , , • to $ . Total Monetary $ $ In -Kind $ (8) Other Distributions $ , , . (9) TOTAL Monetary Contributions To Date $ , 16 , 964 . 85 (10) TOTAL Monetary Expenditures To Date $ , 10 , 000 , 00 (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Brian J. Aungst, Jr. to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, JR. ■ Individual (only for IE ❑ Treasurer 0 Deputy Treasurer ❑ Candidate El Chairperson (only for PC and PTY) i /,---- X /-5 or electioneering comm.) X Signature 9 Signature g DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS (1) Name CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. 2 (3) Cover Period (2) I.D. Number 13 16 2 23 16 / / through / / (4) Page 1 of DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number 2 / 17 / 16 The Tropics Boat Tours 25 Causeway Blvd., Clearwater, FL 33767 B Boat tours CHE $500 G2 -1 2 / 23 / 16 Zvi Blech 2701 Flatbush Ave. # 26, Brooklyn, NY 11234 I Real estate CHE $964.85 G2-2 / / / / / / / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater Matters, Inc. (2) I.D. Number (3) Cover Period 2 / 13 / 16 through 2 / 26 / 16 (4) Page 1 of 1 (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number 2 /17 if 16 Data Targeting, Inc. 6211 NW 132nd Street Gainesville, FL 32653 Campaign Mailer IEI $5,000 G2 -1 2 22 16 / / Data Targeting, Inc. 6211 NW 132nd Street Gainesville, FL 32653 Campaign Mailer IEI $5,000 C2 -2 / / / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY OF msg. ONLY CHI/ED FEB 1 9 20T6 OFFICIAL CC�R2DS AND LEGISLATIVE Name (2) 600 Cleveland Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code ❑ Check here if address has changed (3) (4) Check appropriate box(es): ❑ Candidate Office Sought: Sk c5 DEPT ID Number: ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed ✓ Political Committee (PC) ❑ Electioneering Communications Org. (ECO) ❑ Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) (5) Report Identifiers Cover Period: From 2 / 1 / 16 To 2 / 12 / 16 Report Type: G -1 ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , 15 , 000. 00 (7) Monetary Expenditures Transfers Office Account Total Monetary Expenditures This Report $ , , 0 . Loans $ , to $ , , • Total Monetary $ • $ , , 0 In -Kind $ • (8) Other Distributions $ . (9) TOTAL Monetary Contributions To Date $ , 15 , 500 , 00 (10) TOTAL Monetary Expenditures To Date $ , , 0 • (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Brian J. Aungst, Jr. to falsify a public record (ss. 839.13, F.S.) and complete: (Type name) Brian J. Aungst, Jr. ❑ Individual (only for IE ❑ Treasurer ❑ Deputy Treasurer or electioneering comm.) X /77. ❑ Candidate GI Chairperson (only for PC and PTY) Signature Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. (1) Name 2 (3) Cover Period 1 16 2 / / through / / 12 (2) I.D. Number 16 1 (4) Page of 1 DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number 2 / 8 / 16 Zev Buffman P.O. Box 951, Crystal Beach, FL 34681 Check CEO Cash $5,000.00 2 / 8 / 16 KnowB4,LLC 33 N. Garden Avenue, Ste 1200, Clearwater, FL 33755 Check Business Cash $5,000.00 2 / 8 / 16 Daniels Ikajevs 600 Cleveland Street, Clearwater, FL 33755 Check CEO Cash $5,000.00 / / / / / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater Matters, Inc. (2) I.D. Number (3) Cover Period 2 / 1 / 16n through 2 / 12 / 16 (4) Page 1 of 1 (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (1 0) Amendment (11) Amount (6) Sequence Number / / None / / / / / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT (1) Clearwater Matters, Inc. SUMMARY OFFICE USE ONLY 7 iF7 Name (2) 600 Cleveland Street, Suite 200 Address (number and street) Clearwater, FL 33756 City, State, Zip Code ❑ Check here if address has changed (3) (4) Check appropriate box(es): ❑ Candidate Office Sought: 1 ID Nu Or: '' ; Political Committee (PC) ❑ Check here if PC or ECO has disbanded ❑ Check here if PTY has disbanded ❑ Check here if no other IE or EC reports will be filed ❑ Electioneering Communications Org. (ECO) ❑ Party Executive Committee (PTY) ❑ Independent Expenditure (IE) (also covers an individual making electioneering communications) (5) Report Identifiers Cover Period: From 01 / 01 / 16 To 01 / 31 / 16 Report Type: M 1 ❑ Original ❑ Amendment ❑ Special Election Report (6) Contributions This Report Cash & Checks $ , , 500. 00 (7) Expenditures Monetary Expenditures Transfers Office Account Total Monetary This Report $ , , 0 . Loans $ , • to $ , , . Total Monetary $ , 500 00 $ , , 0 . In -Kind $ (8) Other Distributions $ , 0 . (9) TOTAL Monetary Contributions To Date $ , , 500 . 00 (10) TOTAL Monetary Expenditures To Date (11) Certification It is a first degree misdemeanor for any person I certify that I have examined this report and it is true, correct, (Type name) Brian Aungst, Jr. to falsify and complete: (Type a public record (ss. 839.13, F.S.) name) Brian Aungst, Jr. ❑ Individual (only for IE ❑ Treasurer (] Deputy Treasurer or electioneering comm.) ❑ Candidate GI Chairperson (only for PC and PTY) 7? Signature /J Signature DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS Clearwater Matters, Inc. (1) Name (3) Cover Period 01 / 01 / 16 01 through / (2) I.D. Number 31 16 (4) Page 1 of (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code Contributor Type (8) Occupation (9) Contribution Type (10) In -kind Description (11) Amendment (12) Amount (6) Sequence Number 01 / 27 / 16 Brian J. Aungst, Jr. 1683 Midnight Pass Way Clearwater, FL 33756 Check Attorney Cash 500.00 / / / / / / / / / / / / DS -DE 13 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES (1) Name Clearwater Matters, Inc. (2) I.D. Number (3) Cover Period 01 / 01 / I through 01 / ` I / 16 (4) Page 1 of 1 (5) Date (7) Full Name (Last, Suffix, First, Middle) Street Address & City, State, Zip Code (8) Purpose (add office sought if contribution to a candidate) (9) Expenditure Type (10) Amendment (11) Amount (6) Sequence Number / / NONE / / / / / / / / / / / / / / DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES STATEMENT OF ORGANIZATION OF POLITICAL COMMITTEE (PLEASE TYPE) OFFICE USE ONLY RFCENTM N « t 07.:''ZAJ. RECORDS AND LEGZIATiVE SRVCS DEPT 1. Full Name of Committee Clearwater Matters, Inc. Telephone (727) 461 -0011 Mailing Address (include city, state and zip code) 600 Cleveland Street, Suite 200, Clearwater, FL 33756 Street Address (include city, state and zip code) 600 Cleveland Street, Suite 200, Clearwater, FL 33756 2. Affiliated or Connected Organizations (includes other committees of continuous existence and political committees) Name of Affiliated or Connected Organization Mailing Address Relationship N/A 3. Area, Scope and Jurisdiction of the Committee Clearwater, FL Municipal Elections 4. Nature of Organization or Organization's Special Interest (e.g., medical, legal, education, etc.) Economic development and commerce 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 Zachary Thorn 600 Cleveland Street, Suite 200, Clearwater, FL 33756 Treasurer DS -DE 5 (Rev. 06/11) — Rule 1S -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) Full Name Mailing Address Committee Title or Position Brian J. Aungst, Jr. 625 Court Street, Suite 200, Clearwater, FL Chairman /President 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 N/A 8. List Any Issues this Committee is Supporting: Passage of referendum question 1 through 7 during List Any Issues this Committee is Opposing: March 15, 2016 Clearwater, FL municipal election 9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party N/A 10. In the Event of Dissolution, What Disposition will be Made of Residual Funds? Funds will be disposed of in accordance with applicable laws 11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds Name of Bank or Depository & Account Number Mailing Address USAmeribank _, 1617 Gulf to Bay Blvd, Clearwater, FL 33765 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 N/A STATE OF Florida Pinellas COUNTY Brian J. Aungst, Jr. , certify that the information in this Statement of Organization is complete, true and correct. X /� J 1/29/16 Signature of Chairm n of Political ommittee Date DS -DE 5 (Rev. 06/11) — Rule 1S -2.017 page 2 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR POLITICAL COMMITTEES (Sections 106.011(1) and 106.021(1), F.S.) CHECK APPROPRIATE BOX: REcEvED JAN 2 9 2;',;: C ' RI RECO ND LEGISLATE W SiiVCS DEPT OFFICE USE ONLY Original Appointment of Treasurer Reappointment of Treasurer I Deputy Treasurer 1. Committee or Organization Clearwater Matters, Inc. 2. Telephone (727 ) 461 -0011 3. Name of Treasurer or Deputy Treasurer 4. Email (optional) Zachary Thorn 5. Telephone (optional) ( ) 6. Mailing Address 600 Cleveland Street, Suite 200, Clearwater, FL 33756 7. Street Address 600 Cleveland Street, Suite 200, Clearwater, FL 33756 8. The following bank has been designated as the Primary Depository $ Secondary Depository 9. Name of Bank USAmeribank 10. Street Address 1617 Gulf to Bay Blvd. 11. City Clearwater 12. State FL 13. Zip Code 33756 14. Signature of Chairman X / -1 % t 15. Name of Chairman (Print or Type) Brian J. Aungst, Jr. Campaign Treasurer's Acceptance of Appointment I, Zachary Thorn do hereby accept the appointment as (Please Print or Type) treasurer or deputy treasurer for Clearwater Matters, Inc. . (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. 1/29/16 X Date igna ure of Campaign Treasurer or Deputy Treasurer DS -DE 6 (Rev. 7/10) i REGISTERED AGENT STATEMENT OF APPOINTMENT (Section 106.022, F.S.) OFFICE USE ONLY fr7Fi icR) „JAN 29 '-L. 077::::AlFla.‘,C*,:i.:1:17, AND LECCLALVE S,3 DEPT Address 1 Original Appointment Change of Appointment Change of Mailing Address Change of Physical Registered Agent and Office Information Name Brian J. Aundst, Jr. Telephone (727) 441-8966 Street Address 625 Court Street, Suite 200 City Clearwater State FL Zip Code 33756 Mailing Address P.O. Box 1669 City Clearwater State FL Zip Code 33756 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 resigna ion and filing it with the applicable filing officer. / 1. r7 1 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 Clearwater Matters, Inc. Street Address Telephone 600 Cleveland Street, Suite 200 (727) 461-0011 City Clearwater State Zip Code FL 33756 7 .../\. 7. Signature of Chairperson Brian J. Aungst, Jr. 1/29/16 Printed Name of Chairperson Date Form DS-DE 41 (revised 6/11)