OFFICE USE ONLY STATEMENT OF ORGANIZATION OF POLITICAL RECE COMMITTEE PLEASE TYPE) 02n cr C. t o ce'sebast/ Of"1„a n 1. Telephone Full Name of Committee 661- 713- 1793 Sebastian Voters Against Gilliams and Parris Mailing Address (include city, state and zip code) 491 Thomas Street Sebastian, Florida 32958 Street Address ( include city, state and zip code) 491 Thomas Street Sebastian, Florida 32958 2. Affiliated or Connected Organizations ( includes other committees of continuous existence and political committees) Name of Affiliated or None-- -- Relationship Mailing Address Connected Organization None -- None-- 3. Area, Scope and Jurisdiction of the Committee Political committee supporting only municipal issues, 4. Nature of Organization or Organization' s Special Interest (e. g., medical, legal, education, etc.) The recall of Sebastian City Council members Damiem Gilliams and Pamela Parris 5. Identify by Name, Address and Position, the Custodian of Books and Accounts ( include treasurer' s name) Tracey Cole Christopher Nunn William Flynn Michael 491 Thomas St, Sebastian, FL 32958 Chair 709 Jordan Ave, Sebastian, FL 32958 Co -Chair 371 Main Street, Sebastian, Co -Chair Goodfellow DS -DE 5 ( Rev. 06111) — Committee Title or Position Mailing Address Full Name FL 32958 Sebastian, FL 32958 Rule 1S- 2. 017 ( Secretary/ Treasurer 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 None— -- Address Committee Title or Position None-- — None - 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 None— -- Address None-- -- Office Sought Party None— — None -- 8. List Any issues this Committee Is Supporting: The recall of Sebastian City Council members Damien List Any Issues this Committee Is Gilliams and Pamela Parris Opposing: __ none - 9. If this Committee is Supporting the Entire Ticket of a Party, Give Name of Party None-10. In the Event of Dissolution, What Disposition will be Made of Residual Funds? Donation to a local non- profit. 11. List all Banks, Safety Deposit Boxes, or Other Depositories Used for Committee Funds Name of Bank or Depository & Account Number Mailing Address Sebastian, FL 32958 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 Dates Required to be Filed I Name & Position of Official Report Title None— None-- Mailing Address None -- None-- I fv i STATE OFF t- oU I c) P ipN V 1 7L Uu- COUNTY I- r14 u-,1 L Organization certify that the information in this Statement of is comlplete, true and correct. X C' 4C_ 1 rat re of Chairman of Political Committee DS -DE 5 ( Rev. 06111) — Rule 15- 2. 017 Lzc) Date page 2