HomeMy WebLinkAboutDepositoryAPPOINTMENT 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. CHECK APPROPRIATE BOX(ES):
R�CE��E I
ALrs ' 301ts'o
Cil Of Ser
OFFICE USE ONLY
Z] 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
Sherrie Matthews code)
4. Telephone 1 5. E-mail address
(772 )473-6757 I smatt0618@comcast.net
Sebsatian, FL 32958
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
Sebastian City Council Member ❑ 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 ® Party candidate.
9. 1 have appointed the following person to act as my
10. Name of Treasurer or Deputy Treasurer
Sherrie Matthews
11. Mailing Address
® Campaign Treasurer ❑ Deputy Treasurer
12. Telephone
( 772 ) 473-6757
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Sebastian Indian River FL 32958 smatt0618@comcast.net
18. 1 have designated the following bank as my ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
21. City 22. County Indian River 23. State 24. Zip Code
Sebastian FL 32958
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/n 26. Sign®lure of Candidate
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Sherrie Matthews , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ® Campaign Treasurer Deputy Treasurer.
Auci�e�sf 8. c)00-eD
Date
elX ?gnature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.