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HomeMy WebLinkAboutDSDE 9APPOINTMENT 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. C}IECK APPROPRIATE t3OX(ES): Initial Filing of Form Re -filing to Change: ❑ 2. Name of Candidate (in this order: First, Middle, Last) RECEIVED JUI AI % 4 Z020 City of tian City Clerkebpffice OFFICE USE ONLY Treasurer/Deputy ❑ Depositary ❑ Office ❑ Party 3. Address (include post office box or street, city, state, zip code) 4. Telephone 5. E-mail address SEBuP5T�/^Jj/2 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if 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 R 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 —e 11. Mailing Address 12. Telephone 13. City 14. County 15. State 16. Zip Code 17. E-mail address ��.s/'.ems , z"s� .� 13� 9 � 8' �ifs°� �D3.>� s �1/_�,•-�,. 18. 1 have designated the following bank as my RPrimary Depository [] Secondary Depository 19. Name of Bank j 20. Address 21. City 22, County 3. State 24. 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 FACTS STATED IN IT ARE TRUE. 25. Date 26. Signature of Candidate 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I,G?��1�F-R�'/�h'` .rr.,/,rr C , do hereby accept the appointment (Please Print or Type Name) designated above as: ©Campaign Treasurer ❑ Deputy Treasurer. r/ at /f a e Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.