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HomeMy WebLinkAboutDSDE 9 PPOINTMENT 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. CCM6CK APPROPRIATE BOX(ES): © Initial Filing of Form Re -filing to Change: ❑ OFFICE U!iE ONLY Treasurer/Deputy ❑ Depository ❑ Office E] Party 2. Name of Candidate (in this order: irst, Middle, Last) 3. Address (include post office box or street, city, stale, zip J�tS AII.6A/ ( ILL. code) p 4. Telephone 5. E-mail address '14 ` S FI sCE�L Cl� (427 ) 0-1-52qb j,Ae kf07E SL6ASMAPi r-L 2558 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: Ei3 R ST(h�/ �Ct K CUvuU L My intent is to run as a Write -In ce ndidate. 8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run aE a Write -In ❑ No Party Affiliation ❑ 9. 1 have appointed the following person to act as my 10. Nam of Treasurer �((Deputy Treasurer 11. Mailing Address 9� 41� S �I Sc t� Ge 13. City 14. County 15. State 16. Zip Code SEQNs-r(kA/ l (LL FL/�32kSg 1011"Campaign Treasurer ❑ Party candidate. Deputy Treasurer 12.Telephone (TO ) 17. E-mail address Sta^@-y(77L-�*att.L, 18. 1 have designated the following bank as my Primary Depository Secondary Depository 19. Na of Ban 20. Address 21. City 22. County 23. State 24. Zip Codc ,C3 E G A I (Volxp 6V&D- �-L 12159 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 THU FACITS STATED IN IT ARE TRUE. 25. Date , L 2Vto 26. x 27. Treasurer's A ceptance of Appointment (fill in th bTanks"and check the appropriate block) I, _� 1 >� ) L L- do hereby accept the appointment (((Please Print or Type Name) designated above as: Q Campaign Treasurer ❑ Deputy Tr surer �Cl2k I2U20 x l Date Signature of ign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.00)1, F.A.C.