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HomeMy WebLinkAboutDSDE9APPOINTMENT 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 ooeninq the campaign account. 1. CHECK APPROPRIATE BOX(ES): ® Initial Filing of Form Re -filing to Change: ❑ RECEIVED - [c City of Sebas(i City C!crk' an C`fce OFFICE USE ONLY Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip code) Charles (Ed) Dodd 906 S Fleming St. 4. Telephone rieddodd62(d).amail.com E-mail address Sebastian, FL 32958 (772 ) 473-5440 6. Office sought (include district, circuit, group number) 17. If a candidate for a nonpartisan office, check if applicable: Sebastain City Council 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 ❑ 9. 1 have appointed the following person to act as my © Campaign Treasurer ❑ 10. Name of Treasurer or Deputy Treasurer Ed Dodd 11. Mailing Address 906 S Fleming St. 13. City 14. County Sebastian I Indian River 18. 1 have designated the following bank as my 19. Name of Bank PNC Party candidate. Deputy Treasurer 12. Telephone ( 772-473-5440 15. State 16. Zip Code 17. E-mail address fl 32958 1 eddodd62(aDgmail.com ® Primary Depository F1 Secondary Depository 20. Address 993 Sebastian Blvd 21. City 22. County 23. State 24. Zip Code Sebastian I 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. Date v 26. Signature of Candidate 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) Ed Dodd _ do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer ❑ Deputy Treasurer. to Signature of Campaign reasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.