HomeMy WebLinkAboutCOY, ANDREA DSDE9, Elig, DS-DE84APPOINTMENT OF CAMPAIGN TREASURER
RECE�V
AND DESIGNATION OF CAMPAIGN
��
DEPOSITORY FOR CANDIDATES
Jut
106.021(1), F.S.)
2015
City Of
(PLEASE PRINT OR TYPE)
CI fY CIE', k3 Offae
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Ig 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
2 C�
Av,cll p
code)
n
CLo,_ �J
sO l
4. Telephone
15. E-mail address
( 770 388- 0 961
Bosco ys)�WL A . A
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
Ca""`�—`\ a
\Sq
applicable:
❑ My intent is to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Write -In ❑ No Parry Affiliation ❑ Parry candidate.
9. 1 have appointed the following person to act as my fR Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
lar. k« Q_ CC -3.
11. Mailing Address
12. Telephone
5�t P��w. ►����.��
R-2,) 39-0%l
13. City
sago a,�
14. County
I , P:,,�<
15. State
FL
16. Zip Code
3a9.sg
17. E-mail addres
Bosco @�ASoI. IqA-
18. 1 have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank
20. Address 16 (( y
�7 L_ 3a9S
21. City
22. County
23. State
24. Zip Code
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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. Signature n id
07 06 a01s
X
27. Treasurers Acceptance of Appointment (fill in the blanks and check the appropriate block)
/n� n
I, H a ck � _ 1 ('7 _ (Z_C> �,z do hereby accept the appointment
(Please PrinV6r Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
06 1,2o IS X4--
Date ignature of Campaign Treasure Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of S Quo. C,ac,i Gd�� .�•� ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X U7 06 o2GIS
Signature of Candi ate ate
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).
��QI1' Cf
SE
HOME OF PELICAN ISLAND
ELIGIBILITY TO HOLD OFFICE
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 (9) year
immediately preceding the final date for qualification as a
candidate for said office."
II /� � Co ./ , candidate for the office
of Council Member, meet the eligibility qualifications to hold office as
required in Section 2.02 of the City of ebastian Charter, above.
Signature of Candidate
Sworn nd subscribed before me this �p — day of
i 2015.
SALLY A, MAID
NotaryPu r
_ • ,, Commission It FF 153543
State of A rida ExplresOctober 5,2018
'� Omeee ilue T, Fen lnwex, BOo3g5.I01B
SEAL
*166.032 Eleclors.--:Ata• pe'r'son who is a resideru of a mauticipality. it has qualifed as an elector ofthis
state, and who registers in the nuomer prescribed ht' gemwal /an• and ordinance aJ'ihe au nicipaliry shall be a
qualified elector of the numicipaliro.
,lls-word/e/ectimt/chm•ter eligihilitr