Amit Bloom - Qualifying Documents APPOINTMENT OF CAMPAIGN TREASURER CITY OF
TUR
AND DESIGNATION OF CAMPAIGN Office of the City
DEPOSITORY FOR CANDIDATES RECEIVED
(Section 106.021(1), F.S.)
(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 786-395-6263 code)
20454 NE 34th Court
4.Telephone 5, E-mail address Aventura, FL 33180
(395 ) 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:
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 1 .Telephone
20454 NE 34th Court ( 786 ) 395-6260
13,City 14, County 15, State 16, Zip Code 17. E-mail address
Aventura Miami-Dade FL 33180 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 33180
UNDER PENALTIES of PERJURY,i DECLARE THAT I HAVE READ THE FOREGOING ORMd FOR APPOINTMENT ENT;OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT T' aAOTs STATED IN IT ARE TRUEM
2 , bate 6. Sig ' lure andidate
12/2/2020`
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.
Cate " Signaiture of Campaign TreWsurer or Deputy Tre4svrpt
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 ?NLY
STATEMENT OF
CANDIDATE CITY OF AVENTURA
(Section 106.023, F.S.) OfficeIClerk
1 1t t� �
(Please print ortype) RECEIVED
,Amit Bloom
candidate for the office of Citv of Aventura QQmrnissimer
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 cer within 10 days after the
Appointment of Car aign Treasurer,rer,and Desighationof Campaign Depository Is` led., Willful,
fallw re to file tide form is 'a first dogree misdemeanor and a civil ° i ,lation of the Campaign
Financing Act which A na + sit In a fine,of up to $1, , (s ,265 1 , Florida
Statutes),.
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............................... ........................
CITY OF AVENTURA
e of the A
I City Clerk
RECEIVED
1 2022 Municipal Election,
Access to the Candidaig andr HaaudhgokWid
Thg ffiLtign � t �da
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
78 -395-6253= r/
lternet olopfon6luber:'
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Ultv of
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2022 Municipal Election
Notice of Caudid=
I, Arnit 8 loom �. (the undersigned), an elector of the City of
Aventura,who has resided con0nuouslr in the City(brat least one (1)year preceding the date
of filing of this Nofi e ofCandidacy, whose residence n the City of Aventura is
0454 CIE 34th CouM Aventura, FL 33180 hereby
announce my candidacy for the office of
Mayor Seat El
Commissioner Seat 2 El
Commissioner Seat 4
Commissioner Seat 6
to be voted rat election n be held e 1 day of November, 2022,and I hereby agree
to serve if elected.
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211
SIgnture ca Candidate
f
Cute and hour of filing:
Received by. RECEI"1 ED
E Visa L. Horvath, Mho � OFFICE
j City ClerkIS upenrisbr of E le bons
ACC G 1
(Co Code Sea 26-311
ALTY OF "ENTURA
30 -8901 + FAX. 05 66-
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DEcLARATIoN AND FIRST AMENDMENT T WAIVER RECEIVED
FOR CANDWATES WHO AGREE TO COMPLY TR
E OF THE CITY CLERK
THE VOLUNTARY STATEMENT OF FAIR CAMPAIGN
s
STATEMENT OF FAIR CAMPAIGN PRACTA5Ek
As a candidate for public office in - e wnt, I byre that politicat issues can be luau tho t appealing to racial,ethdw.
religious,sensual, or other preJudices. 1'recognize that such ne a appeals serve only to dive this community munity and create long-term moral, social,
and economic problems. Therefore, CITY OF AVENTURA
1 1 shall rot mare my race, religion, national origin,gender, physical disability, or sexual orientation an issue in MY campaign.
2 1 Ag not mahe my opponen's race, religion, national origin,gender, physical disability, or sexual orientation an issue in my campaign.
3 1 wig comlemn any appeal to dice based on race, creed, national ongin, religion, gender,plocal disability, or isexual orientation.
4 1 M not without lust cause, attack or question my oppontofs P20i0lism
S. 1 shad not publish, display, or circulate jqanonymous campaign literature or political advertisement.
6. 1 *4 not tolerate my supporters engaging in these activities that 1 randernn, nor shot l accept their corned suet if they enga in
such ° iities, I wig not permit any member of my campaign o iration to en in't se activities will immediately publidy
repudiate the support of any other individual or group that resorts to the methods and tactics 1 condemn.
L 1 SM run a posit`positk campaign empt 16ng my qualifications for office and positions on issues of public concern.
g 1 wit limit my attacks on an opponent to legitimate chalenges to that pe 's record, qualifications, and positions..
4 1 will neither use nor permit the;use of menus untruths or innuendoes about an opponen's personal life, not wit 1 make or condone
unfounded accusations discrediting that persons tribility.ed
10. 1 will personal ability for approving or disav ng the substance of s on my opponent mat , y e from thudparties
supporting my candidR.
F it. 1 i not use or permit the use of care material that�ifies, ors rts, or misrepresents facts.
IIY SIGNING THIS DECLARATION AND FIRST AMENDMENT WAIVER,I AGREE T
ARSE BY THE VOLUNTARY STATEMENT OF FAIR CAMPAIGN PRACTICESt
SUBMIT TO THE COMPULSORY JURISDICTION OF THE ETHICS COMMISSION,AND
WAIVE ]]b T AMENDMENT
RIGHTS.
( t a candidate for the office of
i cdo
r,� �0ucr* �acw
n
agree to abide by the voluntary Statement of FairCanapaign Practices as provided in Section 2-11.1.1(Iy)(1)Of
the Ccn&of Miami-Dade,County,Florida,and to recognize as compulsory the,jurisdiction of the Ethics
Commission.I Anther a the `cs Commission will have the authority to decide h I have
viola voluntaryStatement of Campaign ices and,if a violation is found,lase s
Commission the authority to impose the appropriatepenalty.if any,which may include an admonition or
public reprimand.I recognize that I have the right before signing this DECLARATION AND FIRST
'AMENDMENT W to consult my Town legal counsel and to request and receive f ithe "cs
Sion an soul opinion to we r y l ed c aigr activities ly violate the
voluntary Statement of Fair Campaign Practices.I also recognize that after signing this agreemnt,I will
continue to have the right to request and receive from the Ethics CGn mussion an advisory opinion regarding
any future campaignlactivities that I may be considering.I hereby proclaim(1)that my agreement to abide by
been
the State t of Fair Campaign Practices is voluntary,knowing,and irntelli ern;( ) t 1 have not
forced,pressured,or otherwise coerced into making this agreement and(3 that I am aware of the vcrlur; ar
e of this rot.I redwoo there is no penalty for refusing to a to abide by the voluntary
natur;t Statement of lair Campaign Practices.I also r 'ze that i signing this mint,I will be forfeiting
rights to which I would otherwise coil under the First Amendment to the .S`. nstitutiort d isle
I,Section ,cif the Constitution of the State of Florida. "
Once the DECLARATION T
NT 7 :7 is signed,it is irrevocable for the duration of the campaign.
l��ture I3
FORM I STATEMENT O2021
pwoop"Ortypo'your ,moot FINANCIAL TE S�t� OFFICE IJB ONLY:
WOW:
addms,agency ram,and postow r;
LAST NAME—FIRST NAME MIDDLE NAME
B,joom l,Amit Za cze .
LIPiaADDRESS RECEIVED
20454 NE 4th CourtOFFICE OF THE C17Y CLERK
Aventura 3 180 Mi '-
NAME OF AGENCY
CITY OF "ENTURA
NAME F OFFICE CR.POSITION HELD OR SOUGHT;
City of Mon Commission
CHECK ONLY IF CANDIDATE OR Ll NF SIIII�LC��tC OR I'PC31hl
rTHIS SECTION _MW SE COMPLETED
DISCLOSURE PE
s
THISSTATEMENT R FLE S YOUR R FI CI L INTERESTS FOR CAL PdI�AR°f NI�II+11 ICI C tVIf�I�R 1a Q .
NER OF CALCULATING ING EPOR' LEINTERESTS: WHICH REQUIRES
f FILERS HAVE THE aN OF USING REPORTING THRESHOLDS T T E AS LUT R&�L VALUES,
FEWER CALCULATIONS,OR USING COMPARATIVE
THRESHOLDS,t tIi/IMIICFi Aft:lJSI�ALL1'BASED ON PERCENTAGE VALUES
II Stru tl n tc►r i r dotall ). CHECK TICS ON YOU ARE U.'INCH(mustG�k�fCIC one):
CC dIpA TIV (PERCENT1a►�THRESHOLDS��L�$9 � � DOLLAR 1t/►►LUI THRESHOLDS
t FSteB
ARY SOUZE tfF INCOME major sources of Incxsrna to fi rc�pr�f tln pin•S se instructions)
2�lia'if nothing to,ram,wrr "none" [kl'"'rllaa`)
J DESCRIPTION tF T SOURCES
OF SOURCE SOURCE'S
E INCOMEUADDRESS PRINCIPAL OUSINESS ACTIVITY
g Stem loo 54 E 34t Court,'Ave u, `L 3 1 graphic sign atd F�c ?
rr
LLC 121 Yellow Brick Rd,"telluride,CO 81435 BeautyE"Or
PART"u secONOAW SOURCOS O I4C€M tl l
, l a ,and r sources of income to bust tsar the reporting
(If� have nothing tO MPOrt,write"none or#nla"
PRINCIPAL BUSINESS
E 7F NAME OR SOURCES �t ►f�R5 ACTK4TY OF SOURCE
BUSINESS ENTITY Of SUSINESS'INCOME OF SOURCE
n/
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m to s at ft
p C I In owned by the ra n i T
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ny
( you I7 rtIr to epert "roa"Or t1 "}
shoots, necessary.
log h344 C
FILINGINSTRUCTIONS rhan
and where to flit this form are
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located at the bottom of page 2.
INSTRUCTIONS an Who must file
this form and how to'fill It Out
Sirs on 0000 S.
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Amit Bloom, continued
s:
PART D---INTANGIBLE PERSONAL PROPERTY Pocks,bands,oartificates of dap dap0sk etc.M See In trUCti n$)
(tf you gave noting to resort,write"none"or"nla") F
B
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH , PROPERTY RELATES
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