Michael Isaac Jacobs - Registration Documents RECEIVED
APPOINTMENT OF CAMPAIGN TREASURER OFFICE OF THE CITY CLERK
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JAN 1 2 2024
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying CITY OF AVENTURA
officer before opening the campaign account. OFFICE USE ONLY
1. HECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: [:] 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
I code)
4. Telephone 5. E-mail address -VL, S3 I 'BD
- 4,C45 Mq M7)-e
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
C74LI F] my intent is to run as a Write-in candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Write-In Ej No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer E] Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
jA,1 s
11. Mailing Address 12. Telephone
2 < 4C 140
13. City 14. County i— 15. State 1 16. Zip Code 17. E-mail address
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20. Address
1 —cs Vd,
21. City 22. County AAt.. 23. State 24. Zip Code
1 S
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. Signature of Candidate
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, k�C"Ic I lalca k) , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
I I Ili
Date Signature of Campaign Treadurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule IS-2.0001, F.A.C.
OFFICE UIV SE ONLY
STATEMENT OF RECEED
CANDIDATE OFFICE OF THE CITY CLERK
(Section 106.023, F.S.) JAN 1 2 2024
(Please print or type)
6111 1 V OF 10AVEIM I U
kkILVA I -S&CO
candidate for the office of
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x 1>1 2
Signature of Candidate Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05111)
/l ( City of
RECEIVED
Aventura
.. OFFICE THE CITY
2024 Municipal Election
CITY OF AVENTURA
Access to the Candidate and Callill3aigns r
Handbook
and
The Election Florida
Candidate:
(Print Name)
Office Sought:
Commissioner Seat 1
Commissioner Seat 3 ❑
Commissioner Seat 5 ❑
1 acknowledge that it is my responsibility to read, understand and follow the
requirements described in the City of Aventura Municipal Candidate Election
resources available on the City of Aventura Website ( ®city f venur ®c ),
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 Code;
List of City Vendors; Voter Registration Guide; Items for Sale from Miami-Dade County Elections
Department; Campaign Financing Forms; Frequently Asked Questions; and Common Reporting
Compliance Errors; as well as website links to the Miami-Dade County Elections Department and
State of Florida Division of Elections.
Acknowledged by:
Signature of Candidate
Date:
Primary Telephone Number:
Alternate Telephone Number: ? `�
E-mail address: W6 6 ,� 6
PHONE: 305-466-8901 FAX: 305-466-8919
www.cityofaventura.com