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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