HomeMy WebLinkAboutDSDE9 PPOINTMENT OF CAMPAIGN TREASURER RECE/VED
AND DESIGNATION OF CAMPAIGN JU
DEPOSITORY FOR CANDIDATES City 6 _ b stla
(Section 106.021(1), F.S.) City Cle k'z p ie
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
HECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: Treasurer/Deputy Depository ❑ Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
1 O2 j NiCno1f_ -] 1 flue Island S%o
4. Telephone 5. E-mail address
(-1'12 )Lis ke\(yolcxo"Scc@9 orr S ebaS�i a n t F 32958
6.Office sought (include district, circuit, group number) 17. If a candidate for a nonpartisan office, check if
5ebas-Vi a r\ Ci+� CouLn6 1 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
10. Name%f Treasurer or Deputy Treasurer
1 P2\,-'1 bi-(`Orr
11. Mailing Address
-l( Island S--
2 Campaign Treasurer Deputy Treasurer
12. Telephone
(`1-12 ) L453-5050
13. City 14. County 15. State 1 16. Zip Code 17. E-mail address
SebasAian kndiQrl Qlver FL 32458 1 Vet lycdlY-ov\SCC@cjmatl•caM
18. 1 have designated the following bank as my
19. Name of Bank
-2"ea s+
21. City 22. County
SebgSA\acl radian
R[ Primary Depository
20. Address
1110 poSelGnd
23. State
Qive- Y I FL
Secondary Depository
2a1 e
V24. Zip Code
3ZgS8
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
J `L l y 5 'Zo zz X' (��
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, lLe � 14 _0 \ x�) n , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
Auw S Z022 X
Date Sgnature of 6impalgn reasLrer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.