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ELIGIBILITY TO HOLD OFFICE o�ca
OF COUNCILMEMBER
Charter Section 2.02 - ELIGIBILITY
"No person shall be eligible to hold the office of council member
unless he or she is a qualified elector* in said city and actually
continually resided in said city for a period of one (1) year
immediately preceding the final date for qualification as a
candidate for said office."
I, candidate for the office
of Council Member, meet the eligibility qualifications to hold office as
required in Section 2.02 of the City of Sebastian Charter, above.
Signature of Candidate J/
Sworn to and subscribed before me this /T4=- day of
210\15.
Notary Pub'
State of Kbrida
tgtiM•rtry�, SALLY A. MAIO
s•: .: Commission 8 FF 153543
SEAL va Expires October 5, 2018
•,Ri,i�"� Ball Tmy FYnlw.we B00.YS iO�B
*166.032 Electors.—Any person who is a resident of a municipality, who has qualified as an elector of this
state, and who registers in the manner• prescribed by general law and ordinance ofthe municipality shall be a
qualified elector of the municipality.
Ms-word/election/charter eligibility
OFFICE USE ONLY
STATEMENT OF RFc
CANDIDATE
(Section 106.023, F.S.) CCitkofs,yZ�%S
(Please print or type) �Cferk'S;a�
ca
candidate for the office of - -
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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Signature of Candidate Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS -DE 84 (05/11)
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
RECF/V�D
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
cut 4 2015
ity Of
RY FO
DEPOSSeOon
Crt,C/ek bastj
10 ORICAFDIDATES
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Na a Of Candidate this order: First, Middle, Last)
, /
3. Address (include post office box or street, city, state, zip
code)
4. Telephone
5. E-mail address
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
Tl q n (- /"� �- &( r, c. / I
applicable:
❑ My intent is to run as a Write -In candidate.
8. If a candidate for aap rtisan office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write -In ❑ No Party Affiliation ❑ Parry candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Na a of Treasurer or Deputy Treasurer
. C- 1I
11. Mailing Address /
/
12. Telephone
13. City
/
14. County
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15. S ate
16. Zip Code
17. E-mail address
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18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of
Bank �,/
20. Address
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21. City L
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22. County
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23. State
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24. Zip Code
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
26. Signatpre of Candidata )
X Y L�
27. Treasurer' Accept nce of Appointment (fill in the blanks and check the appropriate block)
1, ! le C / < <- l 7 ; t 1 do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer..
T�y%�� X /I;
Date Signature'of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.