HomeMy WebLinkAboutGILLMOR, RICHARD DSDE9DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
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DEPOSSecORY
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fion 106OR1CAFDIDATES
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(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):
p Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
Id.Ml'N .—l: 67%1 mor-
code) .7yy Kj"ctG'qe`1_/��P�
< � 7i1//
JL-� ( /
4. Telephone
5. E-mail address
(771. ) `Y I � 8387
1 NyT j I(nlor rrini��c
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6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
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CITY W t)Nc I L-
applicable:
My intent is Write-In
❑ to run as a 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 ❑ Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. N;of Treasurer or DeputyTreasurer
rch�)vd GDI11r&y� ,
11. Mailing Address
12. Telephone
.7 q`( Kroee;CI hl",
(77L-)�53rj
13. 911y
C'l
14. County
�r41)
15. State
16. Zip Code
17. E-mail address
Ems//A
tU
j,a`l Sw
18. 1 have designated the following bank as my Q Primary Depository Secondary Depository
19. Name of Bank
C��cLC'JFis'�
20. Address ,9
`CINd Rod,
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21. City l
C� E'G S A!
22. Cou.{�ty �,
1 A c{ Aq nT K r UP I--
23. State
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24. Zip Code
3
,. Ct 7 r4
l
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
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27. Treasurer's Acceptance of Appointment (FII in the blanks and check the appropriate block)
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I, ' ���AV L t (//nom do hereby accept the appointment
(Please Print or Type Name)
designated a ove a Campaign Tu Treasurer.
�-�/ ieuty
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.