HomeMy WebLinkAboutDSDE9APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 2��9
DEPOSITORY FOR CANDIDATES (,150, bao�t�c
(Section 106.021(1), F.S.) d
(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) 13. Address (include post office box or streetcity, state, zip
)NGh2t� code) /9D
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4. Telephone 5. E-mail address
01i )�5�3�'-0�53IIjNb L)0ll--,4A leo%Cd
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan, officer check If
y C / applicable: C Q a C, ❑ My intent is to run asa Write -In candidate.
S. If a candidate for aap rtisan office, check block and fill in name of parbj 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. Name Of Treasurer or Deputy Treasurer
IVR N6/ ✓e;,b
11. Mailing Address 12- Telephone
3s� '� A Al Y4 -A) s T gl3 -24, 7Y
13. City 14. County 15. State 16, Zip Code 1 17. E-mail address
_5E/3AST1AfJ I)ND RI✓ed I3a9S
18.1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20- Address
i �� � Prnl K � � 3 � 33 ✓I
21. City 22. County23. State { s � 24. Zip Code
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.5 F f3 1-x-5Tih /p✓U' � I ✓2 I 2- /- (,-f 3a 9UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE, li
25. Date c, , 26. Signature Candidate
27. p Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
/
I. II\��A .Vl i L V e ( �4 _ , do hereby accept the appointment
(Please Print or Type Name)
designated above as. Campaign Treasurer ❑ Deou.j Treasurer
Data^r� SignahreompaignTreasararo}DeputyTreasurer
DS -DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.