Bloom 2021-M5 Report CAMPAIGN TREASURERS, REPORT
() Am it, Bbom, OFFICE USE ONLY
Name CITY OF AVENTURA
( ) 2D454 NE 34 Court Officethe City Clerk
Address rstreet)
RECEIVED 6/8/2021
City, State, ;P
E] Ch,o,ck mere If address has thangod ( )° ID Number:
r:
y check �ropri t hra ( )
Candid we f ice Soughl, ve ntl ra Commisslion Seat
w ee� ma n
Eloctioneering,CGmrr`unic iions Org.(FCO) Chick here ifPC or ECOhas diabandad
Party a ewfiv orrrmittee ( T ) [],Check mere il"PTY has disbanded
Indlepand nt Expendillure it (also covers an, Chick here,ii"no other It r EC reports w11111 be filed
ind,iv�du i making h t rira r r��rr irrsr stir r `i
�5) report Identifiers
Cover Period. From 05 101 t To 05 131 12021 Report Type:
21 rigir l Amendment Special 51ection p rt
Contributions This Report ( � Expenditures This Report
on tar °
Cash & ChecksExpenditures
Wan 1W00 Transfers,t
Office Account
Total:Monetary $
rY.
of l Monetary
( I Other Di tri ti n
( ) TOTAL Moneloty Gontributions To Date (t TOTAL Monetary Expenditures To Date
11 '00
(17)Gertification
ft Is a first degree milisdemanor for and porson to falsify a public record f m, . ®t ,F.S.
i certify that i ihave examined iris r pori.and it is this,correct, and:complew
(ryrA name) Davit Bloom (Ty-p natr� ), it loam
.�
Z l a ° � n Y Ja, i � v
ak ,��,
I �t�r� .�
r� Signature
V -0c 1 (Aay.1111 ) SEE REVERSE FOR iNSTRUMONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
Amit Bloom
(1) Name (2) I.D. Number
05 01 2021 05 31 2021 1 1
(3) Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-kind
Number City, State,Zip Code Type Occupation Type Description Amendment Amount
05 25 2021 Bloom, Amit
/ / Q 20454 NE 34 Court
Aventura, FL 33180 S LOA $100.00
1
DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES