HomeMy WebLinkAboutDSDE9, DSDE84, EligibilityDS -DE 9 (Rev. 10!10) Rule iS-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
REG�\v�D
L 2��6
0
DEPOSITORY FOR CANDIDATES
FFA astlan
,e
(Section 106.021(1), F.S.)
C\ty C\Se,j
GI11
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. C)tECK APPROPRIATE BOX(ES):
U 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, stale, zip
41ephone
code)owe S Gl7!/�j/d2buJ
C�zr,� G I7r[� 3Z /v 0
5. E-mail address
(772 )202-3203
>g1ca2�v/dol/„vG
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
GU N
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 Party Affiliation ❑ Party candidate.
9.1 have appointed the following person to act as my 02--Eampaign Treasurer ❑ Deputy Treasurer
10., Nie of Treasurer D Treas rer
�JF� .�0tLLJ
11. Mailing Address
'-> U� 5 rwc/3e.o� ��
12. Telephone
c77u2oz-3zf3
13. City
14. County
1.5 -stale
16. Zip Code
17. E-mail address
S'15 _I ;
LYz
vE-”
r oFTIiA-6
18.1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank
(1-6 N A) )I--
20. Addre
1 r o2Ds'16—CAA4b
21. City 22. County
�
23.
24. Zip Code
r No
3�95'b
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOR)260—N FORM FOR APPOJNUkENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AN THAT TRf FACT "STr IN ITVE TRUE.
25. Date f � 1
. ignatur of Can a
27. Treasu , ceptance of Appointment (fill in the blanks and check the appropriate
do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasur Depuburer.
//
Z rl� X
Date Signature of Cdinpaign Treasurer or u asurer
DS -DE 9 (Rev. 10!10) Rule iS-2.0001, F.A.C.
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of & a v.ye t
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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 S1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
V J'UG 0 f tvj, 1 1
L nOf
SE13AS
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 (1) year
immediately preceding the final date for qualification as a
candidate for said office."
I, T (L)O-U U candidate for the office
of C unci) Member, meet the eligibility qualifications to hold office as
re ire in Section 2.02 of the City of Sebastian Charter, above.
re of Candidate
Sworn to and subscribed before me this
2016.
Notary Public
State of Florida
SEAL
*166.032 Electors.--Anypersonwho i
state, and who registers in the manner
qualified elector ofthe municipality.
Ms-word/electionlcharter eligibility
�— day of
,Va municipality, who has qualified as an elector ofthis
by general law and ordinance of the municipality shall be a