HomeMy WebLinkAboutDSDE9 RefileDS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
RECEIVED
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
APR c 6 2016
DEPOSITORY FOR CANDIDATES
City of
(Section 106-021 (1), F.S.)
City Clerk'sBastian
Once
(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: XO Treasurer/Deputy [] Depository L] 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 Dodd
code
906 S leming St
4. Telephone 5. E-mail address
Sebastian FL 32958
(772 ) 473-5440 1eddodd62@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.
S. If a candidate fora Partisan office, check block and fill in name of party as applicable: My intent is to run as a
E] Write -In O No Party Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer Q Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Charles E. Dodd
11. Mailing Address
12. Telephone
906 Fleming St
( 772 ) 473-5440
13. City
14. County
15. State
16. Zip Code
17. E-mail address
Sebastian
Indian River
IFL
32958
eddodd62@gmail.com
18. 1 have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank
20. Address
21. City
22. County
23. State
24. Zip Code
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. Signature Candidal
4/22/2016
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Charles E. Dodd do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer X❑ Deputy Treasurer.
4/22/2016 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.