Gongora, Michael submitted June 12, 2023MIAMI 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 fund raising 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.
Address (number and street)
City, State, Zip Code
OFFICE USE ONLY
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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.
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"f/i Candidate for the offices of Miami Beach Mayor or Commissioner
one.. \\a4
L] Member of the Miami Beach City Commission
Office:-----------------------------------
I will be commencing solicitation activities on behalf r [].
3 61cal committee
[] Electioneering Communications Organization
• Full Name of the Political Committee or Electioneering Communications Organization:
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• Address of the Political Committee or Electioneering Communications Organization:
2000 50-u«4 l ,Ste i,at6d±EL 374
• Telephone number of the Political Committee or Electioneering Communications Organization:
(3.SO4- 0777
• 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:
• 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):
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• Describe the relationship between the Candidate or member of the City Commission (as applicable)
and the Political Committee or Electioneering Communications Organization:
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C E R T IF IC A T IO N
It is a first-degree misdemeanor for any person to falsify a public record (sec. 839.13, Fla. 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.
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EE Type or Print Name
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Date
L] Elected Official ~ 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@miamibeachfl.gov. 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.
F:\CLERICLER\000_ELECTION\aaFORMS\MBCC 1 - REPORTING OF SOLICITATION OF CONTRIBUTIONS FOR PC & ECO.docx