HomeMy WebLinkAboutDepository AmendedAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES A/fr
(Section 106.021(1), F.S.) C!r 3 -
Of Z020
(PLEASE PRINT OR TYPE) CI tl GoSebasbarl
Cf c"
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re -filing to Change: �K( Treasurer/Deputy ❑ Depository
2. Name of Candidate (in this order: First, Middle, Last)
/
4. Telephone 5. E-mail address
(egg-J37/% Lao &c,�j✓40.4a,e`
6. Office sought (include district, circuit, group number)
OFFICE USE ONLY
❑ Office ❑ Party
3. Address (include post office box or street, city, state, zip
code)
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 ❑ No Party Affiliation ❑ -1d/'_ Party candidate.
9. 1 have appointed the following person to act as my ❑ Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Lov,�e. i<�Urevbv��
11. Mailing Address 12. Telephone
q73 (77,2 ) loglo 371
13. City 14. County 1 State 16. Zip Code 17. E-mail address
�d467-1 Ad��!�w�; ✓� 45sg "1"
18. 1 have designated the following bank as my
19. Name of Bank
21. City ] 22. Coun,t�yj,
,_W,4sTi�il/ ji)d,;�,J,rVez
0 Primary Depository Secondary Depository
20. Address
4-7
23. State 24. Zip Code
Fl 15A�8
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
503/ao X ���
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, ! O U fse_ )(� o7a..e)Za r0 do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Tr surer.
DatefCampaign Treasu r or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.