Cindy Orlinsky - Registration Documents OFFICE USE ONLY
STATEMENT OF RECEIVED
CANDIDATE OFFICE OF THE CITY CLERK
(Section 106.023, F.S.)
(Please print or type) AUG 7 2024
CITY OF AVENTURA
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candidate for the office of nA&j2_have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X PA
Signat e of tandidateu '-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)
_ARECEIVED
City of
-ura OFFICE OF THE CITY CLERK
AvenA
2024 Special Election A U G 7 2024
CrTYINFAVENTURA
Access to the Candidate and Campaign TreasurerHandbook
d
e Election Laws of the State of Florida
Candidate: k JC�A
(Print Name)
Office Sought:
Commissioner Seat 2 FV
I acknowledge that it is my responsibility to read, understand and follow the
requirements described in the City of Aventura Special Election Candidate
Information resources available on the City of Aventura Website
( aciyoavenuraaco ), 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 Elec s.
i
Acknowledged by: _
Signature of Can ate
Date: � � 2 �
Primary Telephone Number: 30 — ±(,,o — Z2
Alternate Telephone Number: g
E-mail address:
PHONE: 305-466-8901 Fax: 305-466-8919
www.cityofaventura.com
APPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES OFFICE OF THE CITY CLERK
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) OCT 3 2024
NOTE: This form must be on file with the filing officer before
opening the campaign account. OFFICE LOSE ONLY,
1. CHECK APPROPRIATE BOX(ES): CITY OF AVEN FM
'Initial Filing of Form ❑ Re-filing to Change:
ATreasurer/Deputy 0 Depository ❑ Office El Party
2. Name of Candidate (in this order: First, Middle, Last): 3.Address (include PO Box or Street, City, State, Zip Code):
(Please Print or X, Type Name)
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4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address:
(not required for qualifying purposes)
7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a non l2artisan office, check the box
if applicable:
E] I intend to run as a Write-in Candidate.
9. If a candidate for 2A_rLiU_n office, check the box and fill in the name of the party as applicable: I intend to run as a
0 Write-In Candidate. ❑ No Party Affiliation Candidate. El Party candidate.
10. 1 have appointed the following person to act as my: El Campaign Treasurer 7\Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
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14. Mailing Address: 15. City: 16. ate: 17. Zip Code:
-2wgi -3j4--11&k- -�St` I ::_� (9 0 1
18. 1 have designated the following bank as my (check appropriate box): El Primary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
21. City: 22. County: 23. State: 24. Zip Code,
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY ANB THAT THE FACTS STATED IN IT ARE TRUE.
26.
25. Date: tore Si Candid
10 2-
27. Treasurer's Acceptance of Appointment (fill in the blanks and check thlk,"p ropriate boQ
1, — do hereby accgpt the appointment designated above as:
(Please Print or Type Name)
❑ Campaign Treasurer. `E_�D puty 7 purer.
T- 8
29. Sig ure o ai 6aign Treasurer or Deputy Treasurer
28. Date-
2
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DS-DE 9 (Rev. 09123) Rule IS-2.0001, F.A.C.