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 opening the campaign account.
1CHECK APPROPRIATE BOX(ES):
4 Initial Filing of Form Re -filing to Change: ❑
2. Name of Candidate (in this order: First, Middle, Last)
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4. Telephone 5. E-mail address
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6. Office sought (include district, circuit, group number)
RECEIVED
City of Sebasi
City Clerk's OffiG
OFFICE USE ONLY
Treasurer/Deputy ❑ Depository ❑ Office ❑ Parry
3. Address (include post office box or street, city, state, zip
code) 913 O:SedJ e jo -M5'
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7. If a candidate for a nonpartisan office, check if
applicable:
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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 Parry 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 12. Telephone
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 Primary Depository ❑ Secondary Depository
19. Name of Bank
City 22. County 23. State 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. Signature of Candidate
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate ock)
1, L A v l-a do hereby accept the appointment
(Please Print or Type Name)
designated above as: 1 Campaign Treasurer ❑ Deputy Treasurer.
X c ��,
Date Stgriature of Cardpalgn Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.