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DS-DE 12 Samuelian 2015-G1
CAMPAIGN TREASURER'S REPORT SUMMARY (1) Mark Samuelian OFFICE USE ONLY Name (2) 10 Venetian Way#1502 (pm Address (number and street) 10. ®9 b 2 015_ Miami Beach, FL 33139 City, State, Zip Code ❑ Check here if address has changed (3) ID Number: (4) Check appropriate box(es): 0 Candidate Office Sought: Miami Beach City Commission, Group 6 ❑ 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 09 /01 /2015 To 10 /02 /2015 Report Type: 2015-G1 Eif Original ❑Amendment ❑ Special Election Report (6) Contributions This Report (7) Expenditures This Report Monetary Cash & Checks $ , 4 ,095 . 00 Expenditures $ , 131,754 . 73 Loans $ , 50, 000 . 00 Transfers to Office Account $ Total Monetary $ , 54, 095. 00 Total Monetary $ , 131 , 754 . 73 In-Kind $ 1 , 771 . 62 (8) Other Distributions $ , 3 , 3eL . 00 (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ , 323 , 662 . 00 $ , 175 , 807 . 96 (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 Candidate ❑Chairperson(only for PC and PTY) or electioneering comm.) gAX X 71,A14dAll Signature Signature DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS � � lc lb CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Mark Samuelian (1) Name (2) I.D. Number 09 01 2015 10 02 2015 1 (3)Cover Period / / through / / (4) Page of Lii (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 Bakkum, Lori 09 03 2015 1446 Lenox Ave #5 / / Miami Beach, FL 33139 1 I Realtor CHE $100.00 Ploehn, Robert 09 / 03 /2015 1450 Lincoln Rd Apt 805 2 Miami Beach, FL 33139 I Retired CHE $250.00 Uratadt, Charles 09 08 2015 16 Island Avenue / / Miami Beach, FL 33139 3 I Realtor CHE $500.00 Frank, Herb 09 / 10 /2015 10 Venetian Way Miami Beach, FL 33139 4 I Retired CHE $250.00 Sylvano'a 09 ' 14 /2015 1925 Liberty Avenue Miami Beach, FL 33139 5 B Restaurant INK Discount $71.62 Greynolds Park 09 14 2015 Village, LLC / / 887 N Shore Drive 6 Miami Beach, FL 33141 B Real Estate CHE $1,000.00 09 14 2015 Townsend, Bruce 1300 Pennsylvania Avenue #200 7 Miami Beach, FL 33139 I Catering CHE $100.00 . Sales DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (F 2 c, C 16 ,,, . CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Mark Samuelian (1) Name (2) I.D. Number 09 01 2015 10 02 2015 2 (3)Cover Period / / through / / (4) Page of if (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last,Suffix,First,Middle) Sequence Street Address 8 Contributor Contribution In-kind Number City,State,Zip Code Type Occupation Type Description Amendment Amount Hernandez, Carlos 09 14 2015 1417 Lenox Avenue / / Miami Beach, FL 33139 8 I Prop Manager CHE $200.00 Del Rio, Gloria 09 / 14 / 734 Meridian Avenue _ #3A 9 Miami Beach, FL 33139 I Designer CHE $25.00 Nelson, Ellen 09 / 14 /2015 100 Lincoln Road #1435 Miami Beach, FL 33139 10 I Retired CHE $50.00 Manning, Jo 09 / / 14 2015 1480 Ocean Drive #408 Miami Beach, FL 33139 11 I Retired CHE $25.00 Breslin, Ray 09 14 2015 255 West 24th Street / / #CU6 12 Miami Beach, FL 33140 I Prop Manager CHE $50.00 Donnelly, James . 09 29 2015 915 Jefferson Avenue / / Miami Beach, FL 33139 13 I Retired CHE $10.00 Roberts, Sherry 09 29 2015 205 S.E. Catawba Road / / Port Clinton, OH 14 43452 I Real Estate CHE $150.00 Broker DS-DE 13(Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES <--Ps.c2_—_- 3 0 C 16 CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Mark Samuelian (1) Name (2) I.D. Number 09 01 2015 10 02 2015 3 Li (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 Richardson, David 09 29 2015 801 Meridian Avenue / / #5g 15 Miami Beach, FL 33139 I Retired CHE $10.00 Stoler, Henry S. 09 / 30 /2015 1500 Ocean Dr. Apt. 803 16 Miami Beach, FL 33139 I Retired CHE $500.00 Stoler, Suzanne J. 09 / 30 /2015 1500 Ocean Dr. Apt. 803 17 Miami Beach, FL 33139 I Retired CHE $500.00 Kozyak, John 09 30 2015 9840 SW 63rd CT / / Miami, FL 33156 28 I Attorney CHE $250.00 Dominguez, Laura 09 30 2015 10 Venetian Way #1502 / / Miami Beach, FL 33139 19 I Sales CHE $100.00 Manager Samuelian, Mark 09 30 2015 10 Venetian Way #1502 / / Miami Beach, FL 33139 20 I Private Fin. LOA $50,000.00 Investor Samueltkr,)Mark ci /30 /Z015 to 4 c 4i an WG.1 Pri ja(¢ Fin Mia � (.sae►. Fl 33iri I Vnd �r es l J� 0500. 00 M aI • DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (--"%12.__ 4 <=0( 1 6 CAMPAIGN TREASURER'S REPORT—ITEMIZED CONTRIBUTIONS Mark Samuelian (1) Name (2) I.D. Number 09 01 2015 10 02 2015 4 4 (3) Cover Period I. / 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 Needle, Mark 09 05 2015 914 Lenox Ave / / Miami Beach, FL 33139 I Educator MON 25.00 22 Danial, Moj 09 30 2015 5151 Collins Avenue / / Miami Beach, FL 33140 I Attorney INK Event F&B $200.00 23 / / / / / / / / / / DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES '-P-_ 5 &C 16 „Ae___ CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)I.D.Number (3)Cover Period 09 / 01 / 2015 through 10 / 02 / 2015 (4)Page 1 of 9 (5) (7) (8) (9) (1 0) (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 The Sharpton Group, P.A. Accounting work 09 it 02/2015 1 SE 3rd Ave., Suite 2100 Miami, FL 33131 MON $3,500.00 1 09 /02/015 USPS Postage 1661 West Avenue Miami Beach, FL 33139 MON $245.00 2 Epicure Food for event 09 /02 /015 1656 Alton Road Miami Beach, FL 33139 MON $37.45 3 Segal, Sherilyn Styling for shoot "r 09 / 0�2015 1508 Bay Road t ', Miami Beach, FL 33139 MON $300.00 4 House Cafe Business Lunch 09 / 02015 9 Island Avenue �` " Miami Beach, FL 33139 MON $32.76 5 Anedot CC Processing Fee 09 /03 2015 5555 Hilton Avenue #106 Baton Rouge, LA 70808 MON $4.20 6 Anedot CC Processing Fee 09 /103 /015 5555 Hilton Avenue #106 Baton Rouge, LA 70808 MON $10.05 7 Comcast Media Buy 09/ 04015 1800 NW 49 Street, Ste. 140, Ft. Lauderdale, FL 33309 MON $8,704.85 8 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (----- 6 0C 1'6 e,: 2,r___ . CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1)Name Mark Samuel i an (2)I.D.Number (3)Cover Period 09 / of /2035 through ]0 /02 / 2015 (4)Page 2 © of 9 (5) (7) (8) (9) (1 0) (11) Date Full Name Purpose (6) (Last,Suffix,First,Middle) (add office sought if Street Address& contribution to a Expenditure Sequence City,State,Zip Code candidate) Type Amendment Amount Number Campaign Statistical Campaign Statistics 09 /04 /2015 1966 NE 123RD STREET North Miami, FL 33161 MON $1,536.00 9 09 //04 /015 Blueprint Consulting Campaign PO Box 310561 Administration Miami, FL 33231 MON $1,200.00 10 Publix Food and beverage 09 /04 /015 1045 Dade Boulevard for event Miami Beach, FL 33139 MON $93.11 s,', 11 ;I .I Manolo Restaurant Event at Restaurant 09 07 2 2015 685 Washington Avenue / Miami Beach, FL 33139 ••" MON $636.20 •";r 12 MDW Communications Video photo shoot . 09 /08/015 601 NW 82nd Avenue #432 and video editing Plantation, FL 33324 MON $1,100.00 13 F n MDW Communications Digital Advertising 09 0�2015 601 NW 82nd Avenue #432 / Plantation, FL 33324 MON $2,762.50 14 MDW Communications Digital/ social 09 /08 /015 601 NW 82nd Avenue #432 media advertising Plantation, FL 33324 MON $1,000.00 15 USGBC South Florida Event at James L. 09 /08 /015 777 Glades Road, Room EE329 Knight Center Boca Raton, FL 33431 MON $20.00 16 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES ( 7 oc-' 16 ,e._.... • CAMPAIGN TREASURER'S REPORT—ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)I.D.Number (3)Cover Period 09 / 01 /2015 through 10 / 02 / 2015 (4)Page 3 of 9 (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 09 /08/2015 5555 Hilton Avenue #106 Baton Rouge, LA 70808 MON $19.80 17 09 /110,/p015 Anedot CC Processing Fee 5555 Hilton Avenue #106 Baton Rouge, LA 70808 MON $10.05 18 09 /10/015 Office Depot Office Supplies 1771 West Avenue (ink & paper) ; Miami Beach, FL 33139 MON $172.24 19 c.� r! . MDW Communications Video, web display, 09 10 2 015 601 NW 82nd Avenue #432 facebook ,--. / Plantation, FL 33324 MON $750.00 ?J :J 20 , Qualifying fee City of Miami Beach -- 09 / 10/015 1700 Convention enter Drive Miami Beach, FL 33139 MON $120.00 21 1 i Fedex Mailed payment for 09 10 2 2015 Alton Road cable / Miami Beach, FL 33139 MON $23.21 22 Publix Beverages for event 09 it 12//015 1920 West Avenue Miami Beach, FL 33139 MON $8.60 23 Messer Caparello, P.A. Legal Issues 09 / 14015 2618 Centennial Place Tallahassee, FL 32308 MON $330.00 24 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES r." ,-%__ 8 aC f g CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)1.D.Number (3)Cover Period 09 / 01 /2015 through 10 / 02 / 2015 (4)Page 4 of 9 (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 La Rosa Bakery Food for voter 09 /14 /2015 4259 W Flagler Street event Coral Gables, FL 33134 MON $83.50 25 09 115/015 National Campaign Resource Group, Poll LLC 11380 Prosperity Farms Road #221E Palm Beach Gardens, FL 33410 MON $9,200.00 26 Sheets, Alysha Data Work 09 / 15/015 603 E Call St. #714 Tallahassee, FL 32301 MON $130.00 27 N. Blueprint Consulting Campaign Admin. 09 15 2 2015 PO Box 310561 / Miami, FL 33231 MON $1,304.00 " ,? 28 r) National Campaign Resource Group, Direct Mail , 09 /16/015 LLC (english/spanish) 11380 Prosperity Farms Road #221E Palm Beach Gardens, FL 33410 MON $37,676.00 29 . '.ti J . Balans Voter Breakfast f.. 09 18 2 2015 1022 Linocln Road / Miami Beach, FL 33139 MON $31.01 30 Community Newspapers 1/2 page newspaper 09 /19/015 6796 SW 62nd Avenue Ad South Miami, FL 33143 MON $525.00 31 La Voz de Miami Beach 1/2 page newspaper PO Box 14085 Ad 09 /19/015 Coral Gables, FL 33114 MON $500.00 r 32 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 9c2I6 CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1)Name Mark Samuel i an (2)I.D.Number (3)Cover Period 09 / 01 /2015 through 10 /02 / 2015 (4)Page 5 of 9 (5) (7) (8) (9) (1 0) (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 Physical Advertising Works Name Badges 09 /19 /2015 6713 NE 3 Ave Miami, FL 33138 MON $35.31 33 09 / I015 22 Vargas, Luis Alberto Entertainment for 480 NW 135th Street event �3ini, FL 34 MON $150.00 La Rosa Bakery Food for voter 09 /22/015 4259 W Flagler St event Coral Gables, FL 33134 MON $12.00 35 Delicias de Espana Food for voter ' 09 22 2 2015 4016 SW 57th Avenue event / / Miami, FL 33155 MON $48.60 36 La Rosa Bakery Food for voter 09 /22 /015 4259 W Flagler St event Coral Gables, FL 33134 +MON $32.10 `■ 37 I i Vargas, Luis Alberto Entertainment for 09 /23 2015 480 NW 135th Street event North Miami, FL MON $150.00 —i- 33168 38 Roasters & Toasters Voter breakfast 09/23 /015 525 Author Godfrey Road Miami Beach, FL 33140 MON $35.87 39 Comcast Media Buy 09/23 /X2015 1800 NW 49 Street Ft. Lauderdale, FL 33309 MON $22,615.00 40 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (<-4 ::74:: e____._ I Dor ./6 CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)I.D.Number (3)Cover Period 09 /01 / 2015 through to /02 / 2015 (4)Page 6 of 9 (5) (7) (8) (9) (1 0) (91) 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 Campaign Statistical Campaign Statistics 09 y/23 )6015 1966 NE 123rd Street North Miami, FL 33161 MON $3,954.90 41 09 / 23/015 5 Comcast Media Buy 1800 NW 49 Street Ft. Lauderdale, FL 33309 MON $12,002.00 42 Campaign Statistical Campaign Statistics 09 123 /015 1966 NE 123RD Street North Miami, FL 33161 MON $2,118.00 43 MDW Communications Photo/ Video shoot 09 23 2015 601 NW 82nd Avenue }432 / // Plantation, FL 33324 MON $2,800.00 44 �;) Publix Food and beverage 09 /23 /015 1045 Dade Boulevard for voter event Miami Beach, FL 33139 MON $107.62 p 45 1 /' 1 Sun Sushi Asian & Grill Voter Lunch 09/ 29/015 1211 71st Street Miami Beach, FL 33141 MON $96.05 46 Publix Food and beverage 09 / 28 /015 1920 West Avenue for event / Miami Beach, FL 33139 MON $230.72 47 La Rosa Bakery Food for events 09 / 28015 4259 West Flagler Street Miami, FL 33134 MON $77.58 48 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES e___. c 1 ®F 1'6 i CAMPAIGN TREASURER'S REPORT—ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)I.D.Number (3)Cover Period 09 / 01 /2015 through 10 / 02 / 2015 (4)Page 7 of 9 (5) (7) (8) (9) ' (10) (1 1) Date Full Name Purpose (6) (Last,Suffix,First,Middle) (add office sought if Expenditure Sequence Street Address& contribution to a P Number City,State,Zip Code candidate) Type Amendment Amount 09 /2,4/2 015 gLiepriA.1 Cosa%vi 19 I(c°++rP41S..1'�a \ �'C �C 31o•ibi 4 350,02. 14-1.fM, Fc 3'323% MON 49 09 / 14015 Campaign Statistical Campaign Statistics 1966 NE 123rd Street North Miami, FL 33161 MON $1,490.15 50 Comcast Media Buy / 09 14 2015 1800 NW 49 Street / Ft. Lauderdale, FL 33309 MON $7,310.85 51 ...I Publix Food and beverage 09 20 2015 1920 West Avenue of events / // Miami Beach, FL 33139 MON $198.56 ' f 52 r---. L.,..,. Publix Food and beverage 09 /29/015 1045 Dade Boulevard of events Miami Beach, FL 33139 MON $183.41 53 _ .mot Anedot CC Processing Fee 09 /294/02015 5555 Hilton Avenue #106 Baton Rouge, LA 70808 MON $0.69 54 Anedot CC Processing Fee 09 /29/015 5555 Hilton Avenue #106 Baton Rouge, LA 70808 MON $6.15 55 Anedot CC Processing Fee 09 /29 X2015 5555 Hilton Avenue #106 / Baton Rouge, LA 70808. MON $0.69 56 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES !!!]r-- [z©( I 6 CAMPAIGN TREASURER'S REPORT-ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)I.D.Number (3)Cover Period 09 / 01 /2015 through to 02 / 2015 (4)Page a of 9 (5) (7) (8) (9) (1 0) (11) Date Full Name Purpose (6) (Last,Suffix,First,Middle) (add office sought if Sequence Street Address 8 contribution to a Expenditure Number City,State,Zip Code candidate) Type Amendment Amount Campaign Statistical Video Production 09 /30/2015 1966 NE 123rd Street North Miami, FL 33161 MON $3,000.00 57 09 /30 4/015 Blueprint Consulting Campaign Admin PO Box 310561 Miami, FL 33231 MON $800.00 58 Publix Food and beverage 09 / 30/015 1920 West Avenue for evnt Miami. Beach, FL 33139 MON $82.39 .. 59 ,/ Vargas, Luis Alberto Entertainment for 09 30 2 2015 480 NW 135th Street Event / North Miami, FL 33168 MON $150.00 60 Decoplage Event Fee 09 /304/2015 100 Lincoln Road Miami Beach, FL 33139 MON $150.00 61 J Publix Food and beverage f 09 /20 1015 1045 Dade Boulevard for event Miami Beach, FL 33139 MON $94.69 62 Sylvano's Voter event 09 /14/015 1925 Liberty Avenue Miami Beach, FL 33139 MON $374.71 63 Vargas, Luis Alberto Entertainment for 09 /29 015 480 NW 135th Street event North Miami, FL 33168 MON $150.00 64 DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (---- e... 1...) Oe (0 CAMPAIGN TREASURER'S REPORT—ITEMIZED EXPENDITURES (1)Name Mark Samuelian (2)I.D.Number (3)Cover Period 09 /01 /2015 through 10 / 02 / 2015 (4)Page 9 ® of 9 (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 Vargas, Luis Alberto Entertainment for 10 /01 /2015 480 NW 135th Street event North Miami, FL 33168 MON $150.00 65 10 /02 /015 Cafe Avanti Voter lunch 732 41st Street Miami Beach, FL 33140 MON $47.24 66 ci icy-Mir 1144 5 A lion t xkJ ',, (Di CIF Moo Q.ry - A 1 /24/Zot gloo NE 4k S e,� M®n1 Ili5eht M (0% ‘Grp i FL 3313? L4 Pra 4 en OZ. Cl /0y/20u 433 Wes I q I S} Scree t o�r cee 20 MiAh i ( eacL. c 33) x _ _.., 64 Anedai A /0C/26' 5555 i-i I}" AventAt *Ow CC pmcess►ri 3a4o Tuye LA 1o'og Mai 1.2� 10 / / / / DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES 2_. ftcc16 ■ CAMPAIGN TREASURER'S REPORT-ITEMIZED DISTRIBUTIONS (1) Name Mark Samuelian (2) I.D. Number (3) Cover Period 09 / 01 / 2015 through 10 / 02 / 2015 (4) Page 1 of (5) (7) (8) (9) (10) (11) (1 2) Date Full Name Purpose (6) (Last,Suffix,First,Middle) (add office sought if Sequence Street Address& contribution to a Related Distribution Number City,State,Zip Code candidate) Expenditures Amendment Amount Type Kozyak, Jeremy Campaign Manager 09 04 2015 PO Box 310561 Miami, FL 33231 2015-G1-10 $1,200.00 PPD 1 Kozyak, Jeremy Campaign Manager 09 15 2015 PO Box 310561 / Miami, FL 33231 2015-G1-28 $1,200.00 PPD 2 Villalon, Isabel Administrative 09 15 2015 PO Box 310561 Services Miami, FL 33231 2015-G1-28 $104.00 PPD 3 Shapiro, Stanley Event Planning 09 30 2015 516 15th street / / Miami Beach, FL 33139 ,1 2105-G1-58 $100.00 PPD a 4 Segarra, Mimi Event Planning 09 30 2015 533 Collins Ave / / Miami Beach, FL 33139 2015-G1-58 $100.00 PPD 5 Fonseca, Coralia Canvassing 09 30 2015 532 Michigan Avenue Miami Beach, FL 33139 2015-G1-58 $100.00 PPD 6 Pimentel, Mercedes Collateral 09 30 2015 718 78 Street distribution at / / Miami Beach, FL 33141 multiple events 2015-G1-58 $100.00 PPD 7 Villalon, Isabel Hispanic Outreach/ 09 30 2015 PO Box 310561 Translations / / Miami, FL 33231 2015-G1-58 $400.00 PPD 8 DS-DE 14A(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES d I e:3 I6 CAMPAIGN LOANS REPORT ITEMIZED Page 1 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: Priv Financial Investor OCCUPATION: AMOUNT OF LOAN: $50,000.00 AMOUNT OF LOAN: DATE RECEIVED: 9/20/2015 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: 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) ( a 16 q y. (305) 764-5089 SHIP DATE:.090CT15 i FROM ACTWGT: 0.20 LB a Laura Dominguet CAD: 6991774/SSF01621 Mark Venetian an Campaign DIMMED: 15 X 10 X 1 10 s r:' 1p Venetian Waif o # 1502 Y. tr Miami beach FL 33139 ____.._.-- — ? In ' TO Rafael Granado -t3 City of Miami Beach 1700 Convention Center Drive • Attn: City Clerk (US) I., Miami beach FL 33139 (000) 000-0000 REF: --- ----- rr -. I �( ij 11111111 li :r 1 Fedo Eu x I` • a 1 ` I I ' I litil I 113', 7 { 854 7769 1. TRK� 7 14 . !, ., 33139 -. .,, . .` I 9622 0019 0 (000 448 3921) 8 00 7814 8854 7769 k fi Millitil Ill I , J 41 } : r.� .r ;',jj '; 1 l• CIA l . i. Y' I a i Fig I I I I I - is-. . . IIIIIIIIIII ; ; I I I I I I I I �,.'• 1 :1: ii „,, i' MOISTURE RESISTANT RESISTANTE A L'HUMIDITE ! ; .1 I : . 100% Recyclable . ;-',fi; 1, -;,sue r �I i