HomeMy WebLinkAboutDSDE9, DSDE84, EligibilityAPPOINTMENT OF CAMPAIGN TREASURER
RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
APR 1 4 2016
(Section 106-021 (1), F.S.)
City of Sebastian
(PLEASE PRINT OR TYPE)
City Clerk's Office
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
I OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑X 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
Charles E. Ed Doddcode
906 S ming St.
le
Sebastian, FI 32958
4. Telephone
5. E-mail address
(772 ) 473-5440
eddodd62@gmail.com
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
Sebastian City Council
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 O No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Q Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
David Brunelle
11. Mailing Address
12. Telephone
762 Holden Ave
( 772 ) 388-2397
13. City
14. County
15. State
16. Zip Code
17. E-mail address
Sebastian
Indian River
Fl_
32958
sdbrun@bellsouth.net
18. I have designated the following bank as my ❑X Primary Depository ❑ Secondary Depository
19. Name of Bank
20. Address
PNC Bank
993 Sebastian Blvd
21. City
22. County
23. State
24. Zip Code
Sebastian
I Indian River
�Fl_
32958
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
Candida
y `� ave
7;7V40_,-C1
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
David Brunelle do hereby accept the appointment
(Please Print or Type Name)
designated above as: Q Campaign Treasurer Deputy Treasurer.
y 3 ic, X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.
RECEIVED
APR 14 2016
CityOf Sebaslia
Clerk's orfs,
My OF
STAN
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, E 11�1-A , 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
Sworn to and subscribed before me this 114"' day of rlQ
2016.
�3:1, SSIOyh' ��,q'!S
Notary Public _ gVO�,%y 28 2Eto S
tate of Floridaso.
'.. #FF 186485 , 5Q7
SEAL °Q`
"!66.032 Electors.--AnY person who is a resident of municipality, who has qualified as an elector of this
.state. and mho registers in the manner prescrihed by general /au and ordinance nlihe nu nicipalinshall he a
guahlied elector of the nine ipalire.
:1 /.v-trust!/election/chrvter eligihilitr
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
1, Charles E, (Ed) Dodd ,
candidate for the office of Sebastian City Council ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X C �1� S Xto l -(-
Signature
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 -DL 84 (05/i I)