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Acknowledgement of electronic filing WalshMiami Shores Village Application and Acknowledgement of Electronic�� Filing Information„ ��'TLS 4PI SA FL4 Rip4` 1. CHECK APPROPRIATE BOX(ES) Candidate ❑ Treasurer/Deputy ❑ Committee ❑ Committee Treasurer 2. Name of Candidate/Co�m�m%ittee (Fi st, Middle, Last) 3. Address (include P.O. box or street, Village, state, ,.� C • 1/ � ped`� i+ s zip code) :v y M ;ern; : 6 df s r Z 33/3F 4. Telephone 5. E-mail address -�,* La i- -10,-4 ri0JS 4 1jms�-R-r, Campaign finance activity may be filed with the Village Clerk using the electronic campaign finance reporting system available online at litt s:llmiarnislioresvilla efl.cas voteca»t ai -nfinatice.com/ (the "System"). Credentials to log into the Systern are approved on an individual basis and may not be shared —even with member of the same campaign or committee. Each user who is approved for credentials is responsible for protecting those credentials from disclosure or compromise. Once credentials have been approved for a user, that user is deerned responsible for every report filed using those credentials until such tirne as the Village Clerk is notified of disclosure or compromise of those credentials. Campaign or committee must immediately notify the Village Clerk if any user associated with that campaign or committee becomes ineligible to hold the credentials issued to that user. Each report must be filed before midnight at the end of the due date. Reports that have been filed late are subject to fines pursuant to Florida Statutes sections 106.07(8) or 106.29(3), as applicable. By filing a report through the Systern, a person (i) is deerned to have electronically signed the report under oath and to have certified the correctness of the report in accordance with Florida Statutes sections 106.07(5) or 106.29(2), as applicable; (ii) is responsible for the accuracy and veracity of the report; and (iii) commits a criminal act by certifying a report that is known to be incorrect, false, or incomplete. A report is deemed filed with the Village Clerk only when the System issues a receipt confirming the date and time at which the report was filed. The systern will issue a separate notice for the subsequent acceptance or rejection of the report by the Village Clerk. Once a report has been filed with the Village Clerk, it may be changed only by filing an amendment to that report. The Village is not responsible for providing the internet access necessary to access the System, and problems with an individual candidate's internet access at a residence, office, coffee shop, etc. do not excuse late filing by that candidate. The Village Clerk will provide an alternate filing deadline for candidates only in the event that the Reporting System is generally inoperable and all candidates filing via electronic means are affected. UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 HAVE READ AND UNDERSTAND THE FOREGOING FORM FOR APPLICATION AND ACKNOWLEDGEMENT OF ELECTRONIC FILING INFORMATION AND THAT THE FACTS STATED IN IT ARE TRUE. 6. Date 7. Signature didatelComnU'tteChair RK6 ao�� 8. Treasurer's Application and Acknowledgement of Electronic Filing Information (fill in the blanks and check the apprapr•iat�e bblac�k)+ / (printed narne), hereby acknowledge that I am representing the Candidat ICornrnittee above as the C`JCampaign Tr rer epttty Treastu'er' r Date Signature of Treasurer or Deputy Treasurer 00293211