HomeMy WebLinkAboutDSDE9APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
1. CHIECK APPROPRIATE BOX(ES):
Q Initial Filing of Form Re -filing to Change: ❑ Trea
2. Name of
Candidate (in Is order: First, Middle, Last)
4. Telephone f 5, E-mail address
6. Office sought (include district, circuit, group number)
cea
C,ty of 4 7019
C.ty Ch keCestrdn
C'`re-e
OFFICE USE ONLY
IurertDeputy ❑ Depository ❑ Office ❑ Party .
3. Address (include post office box or street, city, state, zip
code)
7. If a candidate for a nonpartisan office, check If
/ applicable:
�y r / I E]My intent is to run as a Write -In candidate.
S. If a candidate for aap rtisan office, check block and fill in name of party as applicable: My intentis fo run as a
❑ Write-in ❑ No Party Affiliation ® Party candidate.
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9. 1 have appointed the following person to act as my ®'Campaign Treasurer ® Deputy Treasurer
10. Na of Treasurer or putq T easurer
11. Mailing Address 112. Telephone ?
13. City 14. County 15. State 16. ZipCode17. E-mail address
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f'-��n �;^- 1,"4.I ��q n� �C'l� ��- J,� /� (�-,,��4 ✓� f0 Ir M� � &Orn I
18.1 have designated the following bank as my []-Prkr.ary Depository ❑ Secondary Depostory
19 -Marne of Bank 20. Address
211-94y 122. County / 123. State 124. 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 FAC73 STATED IN IT ARE TRUE.. I
25, Date 1 26. S lgnatyrej Candidat
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, DL do hereby accept the appointment
(Please Print or Type Name)
designated above as:. L N Campaign Treasurer ❑ Deouty Treas rer
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (P,ay. 10110) Rule 1S-2.0001, F.A.C.