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HomeMy WebLinkAboutDSDE 9APPOINTMENT OF CAMPAIGN TREASURERAND DESIGNATION OF Cn ZOj� DEPOSITORY FOR CAND DA� SN Cr/J C/o k`60s/, an (Section 106.021(1), F.S.) Crfce (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 once box or street, city, state, zip Charles (Ed) Dodd I code) 906 S Fleming St. 4 Telephone 5 E-mail address I Sebastian, FL 32958 ( 772) 3885440 1 edodd0amail.com 6. Office sought (include district, circuit, group number) City Council 7. If a candidate fora nonpartisan office, check if applicable: ❑ My intent is to run as a Write -In candidate. B. 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 © Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Ed Dodd 11. Mailing Address 12. Telephone 906 S. Fleming St. ( 77J 3885"0 13. City 14. County 15. State 16. Zip Code 1 17. E-mail address Sebastian Indian River FL 32958 eddodd62@gmail.com 18. 1 have designated the following bank as my ® Primary Depository Secondary Depositary 19. Name of Bank 20. Address PNC Bank 1 993 Sebastian Blvd 21. City 22. County 23. Stale 24. Zip Cade Sebastian Indian River I FL 1 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. Dale 26. Signature of and date S- I `dU 17,n .2 Or X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, Charles E. Dodd do hereby accept the appointment (Please Print or Type Name) designated above as ® Campaign Treasurer ❑ Deputy Treasurer. rS)qLc,Vatate X Signa ure of 'a�(�-! e mpalgn reasurer or Deputy Treasurer DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.