HomeMy WebLinkAboutDSDE9, DSDE84, EligibilityDS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
RECEIVE[)
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
SEP ,
DEPOSITORY FOR CANDIDATES
9
City Of 2016
(Section 106.021(1), F.S.)
st
CttyCte k ba0 laf;
ffice
(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 CK 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, state, zip
Loot- G% Num �t-v
code)
�ip3 �c.�rts �,/vlv2
�[ ` c/ 3.). cJT
Somas /4^/
4. Telephone
5. E-mail address
(7)z)3�S-aoZo
/ ,, nI rW c�.t'��CrJl� .GSM
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
C J / \
J� u o..t,�'1G CoON� –� �.„� 1
applicable:
E]My intent is to run as a Write -In candidate.
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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 /r Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deput Treasurer
/0/t 'n).k tt-,e
11. Mailing Address
12. Telephone
1&2? us
( 772 ) 3 yy- Y /V7
13. City
14. County15.
ate
16. Zip Code
25S
17. E-mail address
cs G� a•% Com
3
n a�ic1
18.1 have designated the following bank as my Er Primary Depository ❑ Secondary Depository
19. Name of Bank
20. Address / J / �1
SC_6&7 /
Oe 1140,
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21. City
22. County
23. State
24. Zip Code
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FL.
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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. Signat re of Candidate
`6/13/1
v✓
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, �,/���� /t/..r` te_o , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Q___�Campaign Treasurer ❑ Deputy Treasurer.
X //3 /i( X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
1, L2�-�"� W, /V �%LQ✓ �
candidate for the office of S
w
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
�:l
of Candidate
shy zi/L0
Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign reasurer 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 $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS -DE 84 (05111)
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HOME OF PELICAN ISLAND
ELIGIBILITY TO HOLD OFFICE
OF COUNCILMEMBER
Charter Section 2.02 - ELIGIBILITY
"No person shall be eligible to hold the office of council member
unless he or she is a qualified elector* in said city and actually
continually resided in said city for a period of one (9) year
immediately preceding the final date for qualification as a
candidate for said office.”
I, lavk'j w. j1)';" , candidate for the office
of Council Member, meet the eligibility qualifications to hold office as
required in Section 2.02 of the City of Sebastian Charter, above.
Signature of Candidate L
Sworn to and subscribed before me this day(of
C
2016.
Q
Not Public
State of Fierida l lks+Vi ra n w
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SEAS o®a. sw
Mblvy Puak. 8t.te m We.t v.01nle
Row E. Webb
611 81h 849st
Huntlnpbn, ��+vv 96701
*766.Q32 -t�1yg16gtnwelewqlnu urmrtadt§'tE1ja municipality who has qualijied as an elector ojthis
state. 2nNld rod !'1$►•tuk4 Sl LI YhPIAt of APh yfAd 1 Lf4l'tJ' genera/ lam mud ordiurnree ojdue municipality steal! hr a
qualified elector ojthe mmticipulin'.
Ms-word/election/charter eligibiligy