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HomeMy WebLinkAboutDSDE 9 AmendedRECEIVED APPOINTMENT OF CAMPAIGN TREASURER Alf ` c LU?i7 AND DESIGNATION OF CAMPAIGN Gty o/ Sebastian DEPOSITORY FOR CANDIDATES City Clerk'; Cifice (Section 106.021(1), F.S.) RECEIVED (PLEASE PRINT OR TYPE) NOTE: This fop must be on file the qualifying — ;yO Seba, QFFICE USE ONLY officer before opening the campaign account. i CI 1. C ECK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: [j/Treasurer/Deputy (7"Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 13. Address (include post office box or street, city, state, zip / code) 4. Telephone 5. E-mail addressSTir�✓j �/2 %C 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: �i�f/ / ❑ 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 ❑ 9. 1 have appointed the following person to act as my 10. Name of Treasurer or Deputy Treasurer 11. Mailing Address Party candidate. —Campaign Treasurer ❑ Deputy Treasurer 12. Telephone 13. City 14. County 15. State 16. Zip Code 17. E-mail address c;45 �.�.. 18. 1 have designated the following bank as my OR'Primary Depository O Secondary Depository 19.�e of Bank 12,Qk 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 2T Treasurer's/Acceptance of Appointment (fill in the blanks and check the appropriate block) /i I �y✓� c do hereby accept the appointment (P(ease Print or Type Name) designated above as: ©Campaign Treasurer ® Deputy Treasurer. DS-DE 9 (Rev.10/10) X Signature of Campaign Treasurer or Deputy Treasurer Rule 1S-2.0001, F.A.C.