HomeMy WebLinkAboutAppt of TreasurerAPPOINTMENT 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):
`j Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy
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C'tyors 204`I
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OFFICE USE ONLY
❑ Depository ❑ Office [] Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
PUVW-e t/1 code) f (� �'✓ U S f S V ` �c / IS
4. Telephone 5. E-mail address q
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6. Office sought (include district, circuit, grou nurn-15er'f 7. If a candidate for a nonpartisan office, check if
5e at. ,L"'10 G 1�/ 60vv C,l 1,V11eWjQ-ZV 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 ❑ Party candidate.
9. 1 have appointed the following person to act as my �a Campaign Treasurer ❑ Deputy Treasurer
10. Narle of Treasurer or Deputy Treasurer
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11. Mailing Address 12. Telephone
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13. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my ZP Primary Depository [] Seconnry Depaitory
19. Name of Bank 20. Address
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22. County 23. tate / 24. Zip Code
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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. Sig a ofCa didate
T
27. Treasurer's Acceptance of Appointment (fill in f(e blanks and check the appropriate block)
I �Gvt/t (f Lee- 'L Fey./ l 7 f l Il cw S do hereby accept the appointment
(Please Print 6r TypeMame)
designated above s:
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bate
�( Campaign Treasurer ❑ Deputy Treasurer.
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natgre o mpaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
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APPOINTMENT OF CAMPAIGN TREASURER cif
AND DESIGNATION OF CAMPAIGN RFCE/ c'/yc fSe �t O,
DEPOSITORY FOR CANDIDATES ,4U VFO e 4 �sfa7, O`er
(Section 106.021(1), F.S.)
11ryOf eb
(PLEASE PRINT OR TYPE) C1 ' C/e ks Os1Ce
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
YM Initial Filing of Form Re -filing to Change: 0 Treasurer/Deputy ❑ Depository Office ❑ Party
2.NName of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, Zip
YaVV\_zV1 be ��i �i�����/1 i code) ��OC � US ��V`�✓ AS
4".7Telephone
l 2 r,� bi? -III 1�5\E-(nail address e
(/ (a) 7 t J' 6V JY-�aWIOS s< 14S
6. Office sought (include district, circuit, grow num eel 7. If a candidate for a nonpartisan office, check if
5&ba(SAi ,i V1 CUC Ic ACV11,61zr applicable:
❑ My intent is to run as a Write -In candidate.
B. If a candidate for a 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
11. Mailing Address SU \ e /� 12. Telephone
�U23 U 51 5e6asI( Av� ( >
13. City I 14.� ounty 15. State 16. Zip Code 17. E-mail address
�e�aSt ail Ilv>,d &M 1;iV-eV �Z�S�i IawAo51eSi w5� -V&P ` (Oct
18. 1 have designated the following bank as my Primary Depository Secon�ry Dep'e�itory
19. Name ot,
Ci ) 22. County � 23. State � 24. Zip Code
S�i�� �i2V(Vf!/
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 a
f � / � 26.S ig a of Ca didate
//' Z(
... Acceptance
Appointment (fill l .,
27. / Treasurer's Aoce tarnce of A n e blanks and check the appropriate block)
1, _Wm ( -e in Lem r � �� (I I / �l �M S , do hereby accept the appointment
(Please Print , r Type ame)
designated above as: Campaign Treasurer ® Deputy Treasurer.
%1h/ x
Date C j4hatire o mpaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.