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Dominguez, Laura submitted October 29, 2024 (2)MIAMI BEACH CITY OF MIAMI BEACH REPORTING OF SOLICITATION OF CONTRIBUTIONS FOR POLITICAL COMMITTEES AND ELECTIONEERING COMMUNICATIONS ORGANIZATIONS In accordance with City of Miami Beach Ordinance 2023-4557,codified in Sections 2-487 through and including 2-490 of the Miami Beach City Code,a candidate for the offices of Mayor or Commissioner or a member of the City Commission must file,prior to engaging in solicitation activities (not otherwise prohibited by the aforementioned City Code sections),this Form to publicly disclose their solicitation fundraising activities for Political Committees or Electioneering Communications Organizations.Upon completion,this Form must be filed with the City Clerk (see filing instructions below),to be filed on a one-time basis disclosing solicitation for a particular Political Committee or Electioneering Communications Organization. OFFICE USE ONLY Elected Official's or CG] po teaches,"@;zo Address (number and st let ) RECEIVED OCT 29 2024 CITY OF MIAMI BEACH OFEI or rue CIT C!ERK City,State,Zip Code Prior to commencing solicitation activities (not otherwise prohibited by Article VII,Division 5,Sections 2-487 through and including 2-490 of the Miami Beach City Code),either directly or indirectly,on behalf of a Political Committee which supports or opposes candidates for City elected office,or Electioneering Communications Organization which makes expenditures for electioneering communications relating to candidates for City elected office or accepts contributions for the purpose of making such electioneering communications,a candidate for the offices of Mayor or Commissioner,or a member of the City Commission shall file this one- time Report with the City Clerk indicating that the candidate or member of the City Commission is undertaking solicitation activities on behalf of such Political Committee or Electioneering Communications Organization. Fino a El. D Candidate for the offices of Miami Beach Mayor or Commissioner Office:-----------------------------------enMember of the Miami Beach City Commission onee.Group 2 I will be commencing solicitation activities on behalf or []. [Lr political Committee L]Electioneering Communications Organization •Full Name of the Political Committee or Electioneering Communications Organization: our Demo croc4 WC •Address of the Political Committee or Electioneering Communications Organization: 1312 •Telephone number of the Political Committee or Electioneering Communications Organization: •Name of the Registered Agent for the Political Committee or Electioneering Communications Organization: •Name of the Chairperson or Treasurer for the Political Committee or Electioneering Communications Organization: Chos ±ul Vel •Name of the jurisdiction where the Political Committee or Electioneering Communications Organization filed its statement of organization (e.g.,either the City of Miami Beach,Miami-Dade County,or the State of Florida): pl4i-pad ovM4 •Describe the relationship between the Candidate or member of the City Commission (as applicable) and the Political Committee or Electioneering Communications Organization: B So@po± REC EIVED 0CT 29 2024 C ITY O F M IAM I BEAC H CFFCE Or HE CT CE BK CERTIFICATION It is a first-degree misdemeanor for any person to falsify a public record (sec.839.13,_Ela.Stat.) hereby acknowledge that it is my responsibility to read,understand,and follow the campaign finance requirements described in this Article VII,Division 5 of the Miami Beach City Code. I certify that I have examined this report and it is true,correct,and complete. Signatureaura Doi4ut Type or Print Name olzw]204 Date l a omcal candidate Form#MBCC 1 Created On May 17,2023 I Ordinance 2023-4557 Once the form is completed,print it,sign it,and submit an electronic copy to the Office of the City Clerk at CityClerk@miamibeachflgoy.You may also mail or hand deliver the form to the Office of the City Clerk, Miami Beach City Hall,1700 Convention Center Drive,Miami Beach,FL 33139. For more information,please contact the Office of the City Clerk at 305.673.7 411 or via email at CityClerk@miamibeachfl.gov. RECEIVED 0€1 29 2024 CITY OF M IAMI BEACH OFFICE OF THE CITY CLERK F:\CLER\CLER\000_ELECTION\aaFORMS\MBCC 1 -REPORTING OF SOLICITATION OF CONTRIBUTIONS FOR PC &ECO.docx