Campaign Loans 3·ftl!CEIVED
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CAMPAIGN LOANS REPORT ITEMIZQ"1bt8~~1~~~rr· ~t~RK
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(PLEASE TYPE)
FULL NAME AND ADDRESS OF LENDER: FULL NAME AND ADDRESS OF LENDER:
Mark Samuelian
1 o Venetian Way #1502
Miami Beach, FL 33139
OCCUPATION: Private Investor OCCUPATION:
AMOUNT OF LOAN: $110,000.00 AMOUNT OF LOAN:
DATE RECEIVED: 7/31/2017 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:
OS-DE 73A (Rev. 08/03)