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MD-ED 28 Mark SamuelianMIAMI -DADE COUNTY ELECTIONS DEPARTMENT REPORTING OF SOLICITATION OF CONTRIBUTIONS FOR POLITICAL COMMITTEES, ELECTIONEERING COMMUNICATIONS ORGANIZATIONS, 501(c)(4) ORGANIZATIONS AND POLITICAL PARTIES OFFICE USE ONLY Name Mark Samuelian Address (number and street) 10 Venetian Way # 1502 City, State, Zip Code Miami Beach, FL . 33139 ❑ CHECK IF ADDRESS HAS CHANGED Filing as: El Elected Official Office: El Miami -Dade County Candidate Office: Municipal Candidate Miami each Office: City Commissioner, GROUP 2 (Name of Municipality) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) f certify that I have examined this report and it is true, correct, and complete. (SECTION APPLICABLE TO CANDIDATES ONLY) (Type name) Treasurer fl Deputy Treasurer Si. ature 10/17/17 Date I certify that I have examined this report and it is true, correct, and complete. (FOR BOTH ELECTED OFFICIALS AND CANDIDATES) mark Samuelian (Type name) 0Elected Official Candidate Signature 10/17/17 Date MD -ED 28 (Rev. 3/1117) REPORTING OF SOLICITATION OF CONTRIBUTIONS FOR POLITICAL COMMITTEES, ELECTIONEERING COMMUNICATIONS ORGANIZATIONS, 501(C)(4) ORGANIZATIONS AND POLITICAL PARTIES This report must be filed by Miami -Dade County and Municipal Elected Officers and Candidates to publicly disclose their fundraising activities for Political Committees, Electioneering Communications Organizations, 501(C)(4) Organizations and Political Parties within five days of commencing solicitation activities, either directly or lndirectly, on behalf of said organization(s). (1) Name Mark Samuelian i E.D. Number (Only for County Candidates) (2) Page of (3) Row Number (4) Name of PC, ECO, 501(c)(4) Organization or Political Party (5) PC, ECO, 501(c)(4) Organization or Political Party (6) Description of Relationship between Candidate /Officer and PC, ECO, 501(c)(4) Organization or Party (7) Date solicitation activities started Engaged Florida PC PC Supporter 10/17/17 MD -ED 28 (Rev. 115117) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES