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Amit Bloom - Registration Documents APPOINTMENT OF CAMPAIGN TREASURER CITY OF TUR AND DESIGNATION OF CAMPAIGN Office of the City DEPOSITORY FOR CANDIDATES RECEIVED (Section 105.021(1), F.S.) 122it � (PEASE PRINT OR TYPE) NOTE:. This form must be can file with the qualifying officer before oLening the campaign account. OFFICE USE ONLY' 1.CHECK APPROPRIATE Bt3X(ES): 0 initial Filing of Form Re-filing to Change: 0 Treasurer/Deputy C] Depository Office Party 2, Name of Candidate(in this order: First, diddle, Last) 3.Address(include post office box or street, city, state,zip Amit Bloom code) 0454 NE 34th Court 4.Telephone 5, E-mail address Aventura, FL 33130 (305 ) 032- 400 amit@sternbloom.com . Office sought(include district, circuit,group number) 7. If a candidate for a nonpartisan office, check if Commissioner Seat 6 applicable: E] my intent is to run as a Write-In candidate. , If a candidate for a partisan office, check block and fill In name of party as applicable; dy intent i to run as a Write-In E] No Party Affiliation [] Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer ( Deputy Treasurer 10. blame of Treasurer or Deputy Treasurer David Bloom 11. Mailing Address 12.Telephone 0454 NE 34th Court ( 785 ) 305-6260 13,City 14, County 15, State 16, Zip Code 17. E-mail address Aventura Miami-Dade FL 33130 david@sternbloom.eom 18.I have designated the following bank as my Primary Depository C] Secondary Depository 19. Name of Bank 20,Address Ocean Bank 20900 NE 3 th Avenue 21, City 22.County 23 State 24. Zip Code Aventura Miami-Dade FL 33130 UNDER PENALTIES of PERJURY,i DECLARE THAT I HAVE READ THE FOREGOING ORMd FOR APPOINTMENT iNTM ENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT T ACTS STATED IN IT ARE TRUEI 2 , bate 8. Sig ' lure andidate 1 /2/3020` 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) 1, David Bloom ,do hereby accept the 'appointment (Please Print or Type Name) designated above as: Campaign Treesu DePU surer. Cato Signaiture of Campaign TreWsurer or Deputy Treai urpt i "8 E t"(Rev i 11t1) APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN CITY OF AVENTURA DEPOSITORY FOR CANDIDATES Office of the City Clerk (Section 106.021(1), F.S.) 12/2/2020 (PLEASE PRINT OR TYPE) NOTE* This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE IBOX(ES): 10 Initial Filing of Form Re-filing to Change: E] Treasurer/Deputy ❑ Depository Office Party 2, Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Amit Bloom code) 20454 NE 34th Court 4.Telephone 5. E-mail address Aventura, FL 33180 (305 ) 932-2400 amit@sternbloom.com 6. office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Commissioner Seat 6 applicable: n my intent is to run as a Write-In candidate. 8. If a candidate fora partisan office, check block and fill In name of party as applicable: My intent is to run as a Write-In E] No Party Affiliation Party candidate. 9. 1 have appointed the following person to act as my E] Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Amit Bloom 11. Mailing Address 12. Telephone 20454 NE 34th Court ( 305 ) 932-2400 13, City 14. County 15. State 16. Zip Code 17. E-mail address Aventura Miami-Dade FL 133180 1 amit@sternbloom.com 18.1 have designated the following bank as my Primary Depository rl Secondary Depository 19. Name of Bank 20. Address Ocean Bank 20900 NE 30th Avenue 21. City 22. County 23. State 24. Zip Code Aventura Miami-Dade FL 33180 UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE. 25. Date 26, SI atur Cand ate 12/2/2020 A X r71111", 27, Treasurer's Acceptance of Appointment(fill In the blanks and check the appropriate block) 1, Amit Bloom do hereby accept the appointment (Please Print or,Type Name) designated above as: F1 Campaign Treasu r Deputy Treasurer. 12/2/2020, , Date Signature of Campaign Treasurer or Deputy Treasurer DS-DE9(Rev. 10/f Ruj'4 .000', OFFICE USE ONLY STATEMENT OF CANDIDATE CITY OF AVENTURA (seal©raos.a2 , F.S. OfficeI (Please print or typed RECEIty Clerk 1 f t 20 ,Amit Bloom candidate for the office of Citv of Aventura QQm[piscjQner have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. x20 " "igrt tU e of Candidate late E dh 'candidate; must file a 'statement with the qualifying ff car within 10 days after the Appointment of Campaign Treasurer,rer,and Desighationof Campaign Depository Is` led., Willful, fallw ra to file tide form is a first dogree misdemeanor and a civil ° i ,lation of the Campaign Financing Act which A may, + s It In a fine,of,up to $1, , (s ,265(1), Florida Statutes),. 771 %// %ii%�i C SwF y 'of ............................... ........................ CITY OF AVENTURA e of the A I City Clerk RECEIVED oi { 1 2022 Municipal Election, Access to the Candidaig andr HaaudhgokWid Thg ffiLtign g t �C a Candidate. 416100M (Print Dame) Mayor Seat Commissioner Seat 2 El Commissioner Seat 4 1 Commissioner Seat 6 IZI I acknowledge that it is my responsibility to read, understand and fallow the requirements described in the City of Aventura Municipal Candidate Election resources available on the City of Aventura Website r.clt ofaventulra.com , including but not limited to: Candidate and Campaign Treasurer handbook, Compilation of the Election Laws of the State of Florida; City of Aventura Charter and Code of Ordinances-, City of Aventura Political Sign Cade, List of City Vendors, `doter Registration Guide, Items for Sale from 'Miami-Dade County Electrons Department; Campaign Financing 'Forms; Frequently Asked Questions; and Common Reporting Compliance Errors; as well as we ite links to the Miami-Dade County Elections Department and Mate of Florida Division of Ele one Acknowled ed by*- gn re of Candidate 12/02/2020 Primary Telephone Number: 35-g32 240 r� // Item/at `elophon6,Number: %;; I r, ''�,�,,S, ,,,,,,, etternaloorn cow ,E*mail r / f ,,, M,'ri„'""`;,, >: i /� .Mirrr, /{l%.��/////i/r ,,,,i�„G%,, ,,wricri,,,a�„,.,c,r,,,, ,//rricv,%, �. 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