HomeMy WebLinkAboutDSDE9, DSDE84, EligibilityAPPOINTMENT OF CAMPAIGN TREASURER
RECEIVED
AND DESIGNATION OF CAMPAIGN
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DEPOSITORY FOR CANDIDATES
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(Section 106.021(1), F.S.)
City of Sebastian
City Clerk's Office
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account
OFFICE USE ONLY
I.-CoEft APPROPRIATE BOX(ES):
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
IVDA L . rt-)
code)
l9t9
716 A/ch-e
S
4. Telephone
5. E-mail address
(i7a)J�3s-Od53
I-1AJb.,).b61FAA1a COM
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
C 1 TY C O aN c- l /
applicable:
❑ My intent is to run as a Write-In candidate.
8. If a candidate fora p.artisan office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write-In No Party Affiliation 11 Party candidate.
9. 1 have appointed the following person to act as my [Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or DepuTreasurer
Nc c e'
11. Mailing Addr ss
12. Telephone
X52
rn z )q ►3-367 �
13. City
14. County
15. State
16. Zip Code
17. E-mail address
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18.1 have designated the following bank as my a Primary Depository Secondary Depository
19. Name of Bank
20. Address
T0 ink
13(03 Urs 1
21. City
22. County 23. State
24. Zip Code
Ik) er I FL
zoq SR.
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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 f Candidate
40 _/-/(�2
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27. Treasurer's Acceptance of Appointment (fill in a blanks and check the appropriate block)
1 c� 2 ( �4
1. I OL n Y, do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer..
(IJ lI h A. X
Date Signature mpaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10!10) Rule 1S-2.0001, F.A.C.
RECEIVEo
JUN -12016
City of Seh-_..
LoLf
SE
14
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, �, IfllM a/, , /<'IIVCAe I -J , 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.
MW •
Sworn to and subscribed before me this /.Sf
2016. p�
40�-
(�Jotary Public
State of Florid.`NE1TE�W11,.'��.,.
SEAL
FF 185795 Q
*166.032 Electors!
state, and who regia
qualified elector of
,Lfs-word/election/chta•ter eligibility
day of TUriC
of a municipali(v, who has qualified as an elector of this
by general law and ordinance of the nauticipality shall be a
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
i, LINDA xllvc-heAl
candidate for the office of C / 7' i C0 AIC-/ 1
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X
Signature of C ndidate 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).
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