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HomeMy WebLinkAboutDepository - Amended PPOINTMENT OF CAMPAIGN TREASURER RFC AND DESIGNATION OF CAMPAIGN ✓J/ DEPOSITORY FOR CANDIDATES y V (Section 106.021(1), F.S.) rj`` 6(�'`� ,, k, Ebas[ia (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK 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 William Patrick Flynn code) 371 Main street 4. Telephone 1 5. E-mail address Sebastian FI 32958 (772 ) 321-8612 IskydiverbiII60@gmaii.com 6. Office sought (include district, circuit, group number) City council of Sebastian FI 32918 7. If a candidate for a nonoartisan office, check If applicable: ❑ My intent is to run as a Write -In Candidate. 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 © Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Mary Ann Michalak 11. Mailing Address 12. Telephone 371 Main st ( ) 13. City 14. County 15. State 16. Zip Code 17. E-mail address Sebastian 11ndian River FI 132958 1 mkmichalak@Yahoo.com 18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address Seacoast Bank 1110 Roseland road 21. City22. County 23. State 24. Zip Code p Sebastian Indian River Florida 32958 UNDER PENALTIES OF PERJURY, 1 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 v Signal a andid_` 7/3/31/2020 /� r 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) Mary Ann Michalak do hereby accept the appointment (Please Print or Type Name) designated above as: Q Campaign Treas r ❑ Deputy Treasu r. 7/31 /2020 Date Sign t re of Cam Ign reasurer or eputy reasure� nQ-nr a ia..' 1Inrvn Rule 1S-2.0001. F.A.C.