HomeMy WebLinkAboutDSDE9, DSDE84, EligibilityDS -DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.
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APPOINTMENT OF CAMPAIGN TREASURER
ANDION OF CAMPAIGN
TFOR
cC%ksbastje
DEPOSITORY CANDIDATES
(Section 106.021(1), F.S.)
ice
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CIjECK 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)
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3. Address (include post office box or street, city, state, zip
code)
code)
A 1 1L�
235 -� p?
Com' I F)r 3Z S
4. Telephone 9
(717 ) 2211-rj2yl�
5. E-mail address
�,'�@�ok�SC t1111( •cOM
6. Office sought (include district, circuit, group number)7.
If a candidate for a nonpartisan office, check if
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L--fUUtiGI. \
applicable:
❑ My intent is to run as a Write -In candidate.
8. If a candidate fora 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 Campaign Treasurer ❑ Deputy Treasurer
10. NameOfTreasur1e(\o`r Deputy Treasurer
J itis. lNO t
11. Mailing Address
ILIA
12. Telephone
13. City
EQia�il,(,,V
14. County
I IC
15. State
F -L
16. Zip Code
17. E-mail address
18. 1 have designated the following bank as my D_-P'nmary Depository ❑ Secondary Depository
19. Naa of Bank
eS
20. ddress
_5� L�\jJ 0.k/ C
21. City
22. Coun
(`-
23. State
�Z
24. Zip Code
325
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. Signal a of andidate
C� Z )
X
27. Treasurer's Acceptance of Appointment (fill in tanks and check the appropriate block)
I, l Jam11 / \ , do hereby accept the appointment
(Please Print or Type Name)
designatedabove s:Campaign Treasurer ❑ Deputy Treasurer.
I Z�((0 X
Date S - 6n tur Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
M
OFFICE USE ONLY
RECE WED
SEP - 6 P016
City of
bastiati
City Clerks OMC,
candidate for the office of
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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
US -0E 84 (05/11)
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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 said1 \office."
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.
of Candidate
Sworn to and subscribed before me this �Pday of Se12tembar
2016.
Notary Public
State of Florida
SEAL
OF 186485 : Q,
*166.032 Electors.--:Irn'NRI1,/ if
state, and udw registers in the Atrpjp
qualilied elector of the mmniciptditr.
AAs-isrrrcUelection/charter eligibility
oja unaicipaliq, it ho has quahlied as an elector of this
Qr general lar and ordinance q% rhe auuricipalinvshall he it