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Gustavo F. Blachman - Qualifying Documents RECEIVED OFFICE OF THE CITY CLERK APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN MAR - 6 2023 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) CITY OF AVENTURA NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1.CHECK APPROPRIATE BOX(ES): X❑ 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 GUSTAVO BLACHMAN code) 3136 NE 212TH ST, AVENTURA, FL 33180 4. Telephone 5. E-mail address (786 ) 229-8009 GUSTAVOBLACHMAN@G6 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if AVENTURA COMMISIONER SEAT 1 applicable: ❑ 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 X❑ No Party Affiliation ® Party candidate. 9. 1 have appointed the following person to act as my ❑X Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer MARINA C BLACHMAN 11. Mailing Address 12. Telephone 3136 NE 212TH ST, ( 305 ) 439-9909 13. City 14. County 15. State 16.Zip Code 17. E-mail address AVENTURA MIAMI DADE FL 33180 marinablachman@hotmail.com 18. 1 have designated the following bank as my ❑X Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address BANK UNITED 19125 BISCAYNE BLVD 21. City 22. County 23. State 24. Zip Code AVENTURA MIAMI DADE IFL 33180 UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR POI TMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT T E FACTS ATED IT ARE TRUE. 25. Date 26. t re of C did MARCH 06, 2023 X 27. Treasurer's Acceptance of Appointment(fill in the ks a d check�*`opriate block) MARINA C. BLACHMAN do hereby accept the appointment (Please Print or Type Name) designated above as: 0 Campaign Treasurer ❑ Dfwuty Treasurer. MARCH 06, 2023 X C"1120�lyn Date kignature of Campaign Treasurer or Deputy Treasurer DS-DE 9(Rev. 1 Oil 0) Rule 1S-2.0001, F.A.C. RECEIVED APPOINTMENT OF CAMPAIGN TREASURER OFFICE OF THE CITY CLERK AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES LIAR - 6 2023 (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) CITY OF "ENTURA NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK 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 <� J S"7 A ,l z (-. L. P WrV1kN code) 3136 Ns21Z �� S � 4. Telephone 5. E-mail address PL 3 3 I RO ( �1$b et-4vwl � � Air,�M L/� I 22981,09 • L-D-LA 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: d -f�I�i4 4r�1 1SS/�f�/ S3�°s-j /1 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 ❑ No Party Affiliation ❑ Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer © Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer G 0 s 7 A,J o �3 L AA-e t->• ,*O 11. Mailing Address 12.Telephone 3134:) ,Ja 2-1 Z 7H S7 22- (foE) 13. City 14. County 15. State 16.Zip Code 17. E-mail address N ew-T oak DA(,g 18. 1 have designated the following bank as my 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 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS ST I ARE TRUE. 25. Date 26. Si natur of Ca' idat X :� 27. Treasurer's Acceptance of Appointment(fill in the bl ks and the a appropriate block) I, US 74,10 5L aC01a4 A-- , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer ® Deputy Trea u r. o 2oZ X Date Sig I r or Deputy Trea urer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. F.1VC�NLY STATEMENT OF CANDIDATE OFFICE OF THE CITY CLERK (Section 106.023, F.S.) MAR - 2023 (Please print or type) CITY OF AVENTURA 1, GUSTAVO BLACHMAN , candidate for the office of AVENTURA COMMISIONER SEAT 1 ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. MARCH 06, 9023 %natui!eXKC didate 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) City ®f RECEIV`D Aventura OFFICE OF THE CITY CLERK 2024 Municipal Election CITY OF AVENTURA Access to the Candidate and Campaign Treasurer Handbook and The Election Laws of the State of Florida i� Candidate: G Q S7 ► S\J L lA CXi"M (Print Name) Office Sought: Commissioner Seat 1 Commissioner Seat 3 ❑ Commissioner Seat 5 ❑ I 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 (www.citvofaventura.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 Code; List of City Vendors; Voter Registration Guide; Items for Sale from Miami-Dade County Elections Department; Campaign Financing Forms; Frequ tly Asked Questions; and Common Reporting Compliance Errors; as well as website links a Miami-Dade County Elections Department and State of Florida Division of EI Acknowledged by: Signatur101 to Date: 03 06 2 0 2 3 Primary Telephone Number: 9 6 2 2- C� -R O7 Alternate Telephone Number: E-mail address: G Q S 13 L igCtjlM A L PHONE: 305-466-8901 9 Fax: 305-466-8919 www.cityofaventura.com APPOINTMENT F CAMPAIGN TREASURER AND DESIGNATION CAMPAIGN DEPOSITORY FOR CANDIDATES Office of the City Clerk (Section 106.021(1), F.S.) RECEIVED 3/7/2023 (PLEASE PRINT OR TYPE) SM NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1.CHECK APPROPRIATE BO (ES): 21 Initial Filing of Form Re-filing to Change: F1 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 GUSTAVO BLACHMAN code) 3136 NE 212TH ST, AVENTURA, FL 3310 4. Telephone 5. E-mail address (786 ) 229-8009 GUSTAVOLACHMAN G 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if AVENTURA COISIOER SEAT 1 applicable: ® y 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 X No Party Affiliation Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer MARINA C BLACHMAN 11. Mailing Address 12. Telephone 3136 NE 212TH ST, ( 305 ) 439-9909 13. City 14. County 15. State 16. Zip Code 17. E-mail address AVENTURA MIAMI DADE FL 33180 marinablachman@hotmaii.com 18. 1 have designated the following bank as my X Primary Depository Secondary Depository 19. Name of Bank 20.Address BANK UNITED 121155 BISCAYE BLVD 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 F CTS STATED IN IT ARE TRUE. 25. Date 26. Signature f Candida MARCH 06, 2023 27. Treasurer's Acceptance of Appointment(fill in the blanlu and check the a opriate block) I MARINA C. LACHMAN , do her y accept the appointment (Please Print or Type Name) designated above as: X Campaign Treasurer Deputy Treasurer. MARCH 06, 2023 Date Si r or Deputy Treasurer DS- E 9(Rev. 1 Oil 0) Rule 15-2.0001, F.A.C. APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATIONCAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106,021(1), F.&) (PLEASE PRINT OR TYPE) RECEIVED 3/8/2023 NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1.CHECK APPROPRIATE O ( S): X Initial Filing of Form ReAling to Change: Treasurer/Deputy Depository 0 Office Party 2. Name of Candidate(in this order: First, Middle, Last) 3-Address(include post office box or street, city, state, zip GUSTAVO BLACHMAN code) 3136 NE 212TH ST, AVENTURA, FL 33180 4. Telephone 5. E-mail address (76 ) 229-8009 GUSTAVOBLACH A G 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if AVENTURA COMMISIONER SEAT 1 applicable: 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 Z No Party Affiliation Party candidate. 9. 1 have appointed the following person to act as my ® Campaign Treasurer )( Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer GUSTAVO BLACH AN 11. Mailing Address 12. Telephone 3136 NE 212TH ST, ( 305 ) 439-9909 13. City 14. County 15. State 16. Zip Code 17, E-mail address AVENTURA MIA MI DADE FL 3310 gustavoblachman@hotmaii.com 18. 1 have designated the following bank as my X Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address BANK UNITED 121155 BISCAYNE BLVD 21. City 22. County 23. State 24. Zip Code AVENTURA MIA MI DADE IFL 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 T E FACTS TA,7$b IN IT ARE TRUE. 25. Date 26. Signatu a of Ca ate MARCH 06, 2023 27. Treasurer's Acceptance of Appointment(fill in the bl4dks an ch he appropriate block) I GUSTAVO LACHAN hereby ccept the appointment (Please Prink or Type Name) designated above as: ® Campaign Treasurer jX Depu Treasurer. MARCH 06, 2023 Date Signature of Ca p ign Trea r Wuty Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C. f }a; City ofRECEIVED OFFICE OF THE CITY CLERK Aventura -3, PP yF 2024 Munk i pal Election 2 2024 Notice of Candiacv I, GUSTAVO F. BL.ACHMAN (the undersigned), an elector of the City of Aventura, who has resided continuously in the City for at least one (1) year preceding the date of filing of this Notice of Candidacy, whose residence in the City of Aventura is 3136 NE 212TH ST, AVENTURA, FLORIDA, 33180 hereby announce my candidacy for the office of: Commissioner Seat 1 Commissioner Seat 3 ❑ Commissioner Seat 5 ❑ to be voted for at the election to be held on the 5t" day of November, 2024, and I hereby agree to serve if elected. Signature of Can&qoe Date and hour of filing: oG . J :0-7 0," " I Received Ellisa L. Horvath, Mlbt City Clerk/Supervisor of Elections [City Code Sec.26-31] PHONE: 305-466-8901 • Fax: 305-466-8919 www.cityofaventura.com CANDIDATE OATH NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) OFFICE C C LFAK Check box only if you are seeking to qualify as a write-in candidate: OFFICEU- ^ G ❑Write-in candidate OFFICE USE ONL Candidatec"TY OF Name to appear on ballot: GUSTAVO F. BLACHMAN Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.) Check box if name includes nickname. ❑ (For use of a nickname,you must complete the Nickname Affidavit on reverse side.) I swear or affirm that I am a candidate for the nonpartisan office of AVENTURA COMMISSIONER (Office) (District#) 1 � , I am a qualified elector of f�9 County, Florida (Circuit#) (Group or Seat#) I am a qualified elector under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state,the term of which office or any part thereof runs concurrent with the office I seek;and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Statement of Outstanding fines, Fees, or Penalties I owe outstanding fines,fees, or penalties,that cumulatively exceed$250,for ethics or campaign finance violations(s. 99.021(1)(d), F.,S.). YES,I Do NO,I Do Not X If you do,you must also specify the amount owed and each entity that levied the same on the reverse side. (786)229-8009 INFO@FORAVENTURA.C( Signature oloandibate All Telephone Number Email Address 3136 NE 212TH T AVENTURA FL 33180 Address of Legal Residence City State ZIP Code STATE OF FLORIDA COUNTY OF Signature of Notary Pul4'e' Print,Type,or Stamp Commissioned Name;of Notary Public below: Sworn to(or affirmed)and subscribed before me by means of online notarization ❑ OR physical presence LJ this�_day of s{ 20 0�`� " �°`"• .o LLISAIr.NOUATPi WOOMMISSION#HH301736 Personally Known OR Produced Identification ❑ o` 'AQc aoa EXPIRES:AUpst 17,2026 Type of Identification Produced: DS-DE 302NP (Eff. 10/2023) Rule 1S-2.0001, F.A.C. onetic pe ing o Name,. Phonetic sp Ili for the audio ballot(not required for qualifying purposes): Print the name phonetically on the line below as you wish it to be "need on the audio ballot as`may be used by persons with disabilities(see instructions on page 3 of this form): L Q4 0-? A-)�J Statement of Outstanding Fines, Fees,or Penalties Pursuant to Section 99.029(1)(d), F.S., each candidate, whether a party candidate, a candidate with no party affiliation, or a write-in candidate,shall, at the time of subscribing to the oath or affirmation,state in writing whether he or she owes any outstanding fines,fees, or penalties that cumulatively exceed$250 for any violations of s.8,Art.`11 of the State Constitution,the Code of Ethics for Public Officers and Employees underpart III of chapter 112,any loll ethics ordinance governing standards of conduct and disclosure requirements,or chapter 106. Amount': Emit ►ffidadit of_Nickname (Only required if,using nickname for the ballot.) My legal name is I am over the age of eighteen(18)and the contents of this affidavit are true and correct. My nickname is I am generally known by this nickname or have used it as part of my legal name. I have not created the nickname to mislead voters. My nickname does not imply I am some other person,constitute a political slogan or otherwise associate me with a cause or issue,or that is obscene or profane. Signature of Candidate: STATE OF FLORIDA COUNTY OF Signature of Notary Public Sworn to (or affirmed)and subscribed before me by means Print,Type,or Stamp Commissioned Name of Notary Public below: of online notarization El OR physical presence ❑ this day of ,20 Personally mown" df produced iden "C"a-tion ❑ Type of Ide ti icatio4ri Produced DS-DE 302NP(Eff. 10/2023) Rule 1S-2.0001, F.A.C. DECLARATION AND FIRST AMENDMENT WAIVER RECEIVED FOR CANDIDATES WHO AGREE TO COMPLY QfiffICE OF THE CITY THE VOLUNTARY STATEMENT OF FAIR CAMPAIGN PRACTICES VOLUNTARY NARY STATEMENT OF FAIR CAMPAIGN &TEd 5 As a candidate for public office in Miami-Dade County, I believe that political issues can be freely debated without appealing to racial, ethnic, religious, sexual, or other prejudices. I recognize that such negative appeals serve only to divide this c d to er a and economic problems. Therefore, 1. 1 shall not make my race, religion, national origin, gender, physical disability, or sexual orientation an issue in my campaign. 2. 1 shall not make my opponents race, religion, national origin, gender, physical disability, or sexual orientation an issue in my campaign. 3. 1 will condemn any appeal to prejudice based on race, creed, national origin, religion, gender, physical disability, or sexual orientation. 4. 1 shall not, without just cause, attack or question my opponent's patriotism. 5. 1 shall not publish, display, or circulate any anonymous campaign literature or political advertisement. 6. 1 shall not tolerate my supporters engaging in these activities that I condemn, nor shall I accept their continued support,if they engage in such activities. I will not permit any member of my campaign organization to engage in these activities and will immediately and publicly repudiate the support of any other-individual or group that resorts to the methods and tactics I condemn. 1. 1 shall run a positive campaign emphasizing my qualifications for office and positions on issues of public concern. 8. 1 will limit my attacks on an opponent to legitimate challenges to that person's record, qualifications, and positions. 9. 1 will neither use nor permit the use of malicious untruths or innuendoes about an opponent's personal life, nor will I make or condone unfounded accusations discrediting that person's credibility. 10. 1 will take personal responsibility for,approving or disavowing the substance of attacks on my opponent that may come from third parties supporting my candidacy. 11. 1 will not use or permit the use of campaign material that falsifies, distorts, or misrepresents facts. BY SIGNING THIS DECLARATION AND FIRST AMENDMENT WAIVER,I AGREE TO ABIDE BY THE VOLUNTARY STATEMENT OF FAIR CAMPAIGN PRACTICES, SUBMIT TO THE COMPULSORY JURISDICTION OF THE ETHICS COMMISSION,AND 45 WAIVE MY FIRST AMENDMENT RIGHTS. I GUSTAVO F. BLACHMAN , a candidaSe r the office of please print your name , z �`/ Gk- AVENTURA COMMISSIONER SEAT 1 in v elective office sought county,municipality,or other:jurisdiction I I ' agree to abide by the voluntary Statement of Fair Campaign Practices as,provided in Section 2-111.1(D)(1) of the Code of Miami-Dade County,Florida, and to recognize as compulsory the jurisdiction of the Ethics Commission. I further agree that the Ethics`Commission will have the authority to decide whether I have violated the voluntary Statement of Fair Campaign Practices and,if a violation is found,the Ethics Commission has the authority to impose the appropriate penalty, if any,which may include an admonition or public reprimand.I recognize that I have the right before signing this DECLARATION AND FIRST AMENDMENT WAIVER to consult my own legal counsel and to request and receive from the Ethics Commission an advisory opinion as to whether my planned campaign activities are likely to violate the voluntary Statement of Fair Campaign Practices.I also recognize that after signing this agreement,I will continue to have the right to request and receive from the Ethics Commission an advisory opinion regarding any future campaign activities that I may be considering. I hereby proclaim(1)that my agreement to abide by the Statement of Fair Campaign Practices is voluntary,knowing, and intelligent;(2)that I have not been forced,pressured, or otherwise coerced into making this agreement; and(3)that I am aware of the voluntary nature of this agreement.I recognize that there is no penalty for refusing to agree to abide by the voluntary Statement of Fair Campaign Practices.I also recognize that in signing this agreement, I will be forfeiting rights to which I would otherwise be entitled under the First Amendment to the U.S.Constitution and Article I, Section 4, of the Constitution of the State of Florida. Once the DECLARATION AND FIRST AMENDMENT WAN is .gned,it is deemed irrevocable for the duration of the campaign. x 2 Sign Date OFFICERECEIVED 2023 Form I - Statement oil Financial, Interests I U G 1 2 2024 General Information Name: Mr Gustavo F Blachman CITY OF AVENTURA Address: 3136 NE 212TH ST,AVENTURA, FL 33180 County: Organization Suborganization Title N/A CANDIDATE FOR Position Agency Name Position sought or held City,Town or Village(Commission or AVENTURA CITY COMMISSION SEAT 1, Council),Governing Board-Form 1 (Effective 6/10/2024) Disclosure Period THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31,2023 . Primary Sources of Income PRIMARY SOURCE OF INCOME(Over$2,500) (Major sources of income to the reporting person) (If you have nothing to report,write"none"or"n/a") Name of Source of Income Source's Address Description of the Source's Principal Business Activity TERRABELLA REALTY, LLC 240 OLD FEDERAL HWY.STE. 108, HALLANDALE BEACH, FLORIDA 33009 REAL ESTATE BROKERAGE GASTON MAYA 20201 NE 29TH PLACE, UNIT D111, RENTAL INCOME FROM INVESTMENT AVENTURA,FLORIDA 33180 PROPERTY Printed from the Florida EFDMS System Page 1 of 3 2023 Form 2Statement of Financial Interests Secondary Sources of Income SECONDARY SOURCES OF INCOME(Major customers,clients,and other sources of income to businesses owned by the reporting person)(if you have nothing to report,write"none"or"n/a") Name of Business Entity blame of Major Sources of Principal Business Business`Income Address of Source Activity of Source 204 OLD FEDERAL HWY,SUITE TERRABELLA REATLY, LLC REAL ESTATE BROKERAGE 108, HALLANDALE BEACH, FL REAL ESTATE BROKERAGE 33009 Real Property REAL PROPERTY(Land, buildings owned by the reporting person) (If you have nothing to report,write"none"or"n/a") Location/Description 20201 NE 29TH PLACE,SUITE D-111,AVENTURA,FLORIDA 33180 Intangible Personal Property INTANGIBLE PERSONAL PROPERTY(Stocks,bonds,certificates of deposit,etc.over$10,000) (If you have nothing to report,write"none"or`=n/a")' Type of Intangible Business Entity to Which the Property Relates N/A Printed from the Florida EFDMS System Page 2 of 3 2023 Form I - Statement of Financial Interests Liabilities LIABILITIES(Major debts valued over$10,000): (If you have nothing to report,write"none"or"n/a") Name of Creditor Address of Creditor UNITED STATES TREASURY INTERNAL REVENUE SERVICE,OGDEN, UT interests in Specified Businesses INTERESTS IN SPECIFIED BUSINESSES(Ownership or positions in certain types of businesses) (If you have nothing to report,write"none"or"n/a") Business Entity##"1 N/A Signature of Filer Gustavof Blachman Digitally signed:06/17/2024 Printed from the Florida EFDMS System Page 3 of 3