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Home My WebLink AboutDSDE 9 PPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) C tl C/C SebaSti e NOTE: This form must be on file with the qualifying officer before opening the campaign account. 1. C�.YIECK APPROPRIATE BOX(ES): Lca1� Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depositary 2. Name of Candidate (in this order: irst, Middle, Last) Michae.l John FYr vik 4. Telephone 5. E-mail address c77�,) g1357o m�atr�el� @t+-.nc�' 6. Office sought (include district, circuit, group number) C O LLY1C I I 1M-e M b-2f OFFICE USE ONLY ❑ Office ❑ Party 3. Address (include post office box or street, city, state, zip code) (R &;� I are a p Am Scba_,�b a-�\, F1_ 32958 T 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 dNo Party Affiliation ❑ Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or De ut Treasurer ItA-V nS 11. Mailing Address 12. Telephone gTtl.n3�7� ��-©182. � ( St',� )&�� (, lK, 14. i D� 15. State ,3ZZg58 J K vy sSV be�l5bl�l� htb 18. 1 have designated the following bank as my 21, Primary Depository ❑ Secondary Depository 19. Name of Bank {� 20. Address r 0(13 rJ�IIKQWY` �I 21. Cit 22. C unty 23. State, 24. Zip Code St ctS+� �- IVA0.n, tom► veV ��o�i C�c� 3z�150` 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 U.S t 7 a o -1-0 27, Treasurer's Acceptance of Appointment (fill in the nks"and chec the appropriate block) 1, C J oI n Kt -as ' ` s , do hereby accept the appointment (Please Print or Type Name) designated above as: (Campaign Treasurer Deputy Treasurer. Date `- S. nature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.