DS-DE 12 Samuelian 2015-M06 • • •
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Mark Samuelian OFFICE USE ONLY ^,
o
Name -
(2) 10 Venetian Way#1502
Address(number and street)
Miami Beach, FL 33139 - o
City, State, Zip Code , --n
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
0 Candidate Office Sought: M j QM► Beach Ci41 Comm;ssi on Geoop V I
❑ Political Committee(PC)
❑ Electioneering Communications Org. (ECO) ❑Check here if PC or ECO has disbanded
❑ Party Executive Committee(PTY) ❑Check here if PTY has disbanded
❑ Independent Expenditure(IE)(also covers an ❑Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 06 / 01 /2015 To 06 / 30 /2015 Report Type: 201 5-M06
l Original ❑Amendment ❑ Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash &Checks $ , 2,220 . 00 Expenditures $ , 4, 599 . 25
Loans $ , 25, 000 . 00 Transfers to
Office Account $
Total Monetary $ , 27, 220 . 00
Total Monetary $ , 4, 599 . 25
In-Kind $ , , 26 . 00
(8) Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , 188 , 827 . 00 $ , 22, 385 . 94
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record (ss.839.13, F.S.)
I certify that I have examined this report and it is true,correct, and complete:
(Type name) Laura Dominguez (Type name)Mark Samuelian
❑Individual(only for IE 0 Treasurer ❑Deputy Treasurer GI Candidate ❑Chairperson(only for PC and PTY)
or electioneering comm.)
x x /
Signature Signature
DS-DE 12(Rev. 11/13) JUL 1 0 2015 SEE REVERSE FOR INSTRUCTIONS
scanned ► u�
CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS
Mark Samuelian
(1) Name (2) I.D. Number
06 01 2015 06 30 2015 2 4
(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
Losson, Jane
06 29 2015 1810 Jefferson Avenue
/ / Miami Beach, FL 33139
I Retired CHE $50.00
8
Manning, Jo
06 29 2015 e
015 1460 Ocean Drive
/
Miami Beach, FL 33139
I Retired CAS $30.00
9
Manning, Nick
06 29 2015 1460 Ocean Drive #508
/ ./ , Miami Beach, FL 33139
I Retired CAS $30.00
10
McNeil, Elizabeth
06 30 2015 1450 N Mangonia Drive
/ / West Palm Beach, FL
33401 I Business Own CHE $100.00
11 L1 r iAliA9
Clifford, Marychris
06 30 2015 17 Park Street
/ / Dorchester, MA 02112
I Print Sales CHE $100.00
12 •
Tiernan, Dan
06 30 2015
/ / 2351 NE 29th Street
Pompano Beach, FL
33064 I Property Own CHE $100.00
13
Fogel, Adi
06 30 2015
20 Island Avenue #1414
/ /
Miami Beach, FL 33139
I Travel Agent CHE $50.00
14
DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
3 04- g
CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS
Mark Samuelian
(1) Name (2) I.D. Number
06 01 2015 06 30 2015 3 4
(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
Biegelsen, Ian
06 30 2015 32 SE 2nd Avenue #521
/ / Delray Beach, FL 33444
I Pvt Fin Adv CHE $250.00
15
Cohen, Norton
06 30 2015 32 Ladue Meadows
/ / Saint Louis, MO 63141
I Finance CHE $25.00
16
Breslin, Ray
06 30 2015 255 West 24th Street
/ /
Miami Beach, FL 331
I Prop Manager CHE $50.00
17
Blake, Brent
06 / 20 /2015 1402 Brickell Bay
Drive #1402
Miami, FL 33131 I VP Finance CHE $50.00
18
Mouzon, Wanda .
06 30 2015 744 10th Street #111
1 /
Miami Beach, FL 33139
I Fin Planner CHE $50.00
19
Rose, Michael
06 30 2015
111 7th Dilido Terrace
/ /
Miami Beach, FL 33139
I Fin Planner CHE $100.00
20
Tate Enterprises
06 30 2015
1175 NE 125th St #102
/
North Miami, FL 33161
B Dvsfd Invst CHE $250.00
21
DS-DE 13(Rev. 11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
Lt :LI,1" g'
CAMPAIGN TREASURER'S REPORT— ITEMIZED CONTRIBUTIONS
Mark Samuelian
(1) Name (2) I.D. Number
06 01 2015 06 30 2015 4 4
(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
Dominguez, Laura
6 30 2015 10 Venetian Way #1502
/ / Miami Beach, FL 33139
I Sls Manager CHE $525.00
22
Samuelian, Mark
6 / 30 /2015 10 Venetian Way #1502
Miami Beach, FL 33139 ru ne.
I Priv Fin Inv INK Cafe, choc $26.00
23
Samuelian, Mark
6 30 2015 10 Venetian Way #1502
/ /
Miami Beach, FL 33139
I Priv Fin Inv LOA $25,000.00
24
1 / /
/ /
/ /
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DS-DE 13(Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
S 4( V
CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name Mark Samuelian (2) I.D. Number
(3)Cover Period 06 / 01 /2015 through 06 / 30 / 2015 (4) Page 1 2
of
(5) (7) (8) (9) (1 0) (1 1)
Date Full Name Purpose
(6) (Last,Suffix,First,Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
MDW Communications June Digital
6i/06 /2015 601 NW 82nd Avenue #432
Plantation, FL 33324
MON $1,000.00
1
6/08 7l5
MDW Communications June / July
▪ 601 NW 82nd Avenue #432 database
▪ Plantation, FL 33324 MON $960.00
2
Saltzman, Nicolle Campaign Aid
6/12 /015 3900.Island Avenue
Aventura, FL 33160
MON $500.00
3
Publix F&B for campaign
6 16 2015 1920 West Avenue event
/ / Miami Beach, FL 33139
MON $143.86
4
Publix F&B for campaign
6 )8 715 1100 6th Street event
Miami Beach, FL 33139 MON $52.38
5
Saltzman, Nicolle Campaign Aid
6 18 2015 3900 Island Avenue
/ J/ Aventura, FL 33160
MON $250.00
6
Publix F&B for campaign
6i,2 z 2p15 1920 West Avenue event
Miami Beach, FL 33139
MON $78.39
7
Anedot CC processing fee
6 /6 015 5555 Hilton Avenue #106
Baton Rouge, LA 70808
MON $2.25
8
DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
(0 e i S/'
CAMPAIGN TREASURER'S REPORT- ITEMIZED EXPENDITURES
(1) Name Mark Samuelian (2) I.D. Number
(3)Cover Period 06 01 �2015 through 06 30 � 2015 (4) Page 2 2
of
(5) (7) (8) (9) (10) (11)
Date Full Name Purpose
(6) (Last,Suffix, First,Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
Anedot CC processing fee
6 /29 /2015 5555 Hilton Avenue #106
Baton Rouge, LA 70808
MON $7.43
9
6 /29 /015 Cafe Avanti F&B for campaign
732 41st Street event
Miami Beach, FL 33140
MON $402.48
10
Anedot CC processing fee
6 /30 /015 5555 Hilton Avenue #106
Baton Rouge, LA 70808 MON $30.67
11
Publix F&B for campaign
6 30 2015 1045 Dade Boulevard event
/ / Miami Beach, FL 33139
MON $71.79
12
MDW Communications Digital
6 /30 /015 601 NW 82nd Avenue #432 Communications & PR
Plantation, FL 33324
MON $1,000.00
13
Sheets, Aly Data work
6 30 2 015 603 E Call Street #704
/
Tallahassee, FL 32301 MON $100.00
14
/ /
15
/ /
16
DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
7 G(
CAMPAIGN LOANS REPORT ITEMIZED
Page 1 p ,of 1
(PLEASE TYPE)
FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER:
Mark Samuelian
10 Venetian Way#1502
Miami Beach, FL 33139
OCCUPATION: Private Financial Invest. OCCUPATION:
AMOUNT OF LOAN: $25,000.00 AMOUNT OF LOAN:
DATE RECEIVED: 6/30/2015 DATE RECEIVED:
FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER:
OCCUPATION: OCCUPATION: = _.
AMOUNT OF LOAN: AMOUNT OF LOAN: - c,
DATE RECEIVED: DATE RECEIVED:
FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER:
OCCUPATION: OCCUPATION:
AMOUNT OF LOAN: AMOUNT OF LOAN:
DATE RECEIVED: DATE RECEIVED:
DS-DE 73A(Rev.08/03)
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