HomeMy WebLinkAboutAppt of Treasurer 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. C(•IECK APPROPRIATE BOX(ES):
4�� ✓Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy
2. Name of Candidate (in this order: First, Middle, Last)
4. Telephone 5. E-mail address
6. Office sought (include district, circuit, group number)
RECEIVED
APR 10 2023
C/ty Of Sebastia
City Clerk's Ol�
fficE
OFFICE USE ONLY
❑ Depository ❑ Office ❑ Party
3. Address (include post office box or street, city, state, zip
code)
s�AsT9.�,% 3�9ss�
7. If a candidate for a nonpartisan office, check if
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 [V] 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 12. Telephone
//-w ' ei 10')9 ) K3-339e
13. City 14. County 15. State 1 16. Zip Code 1 17. E-mail address
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18. 1 have designated the following bank as my V Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
21. City 22. County _ 23. State I 9A. Zip Code
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
�---.
byr%7Vz3 x =—
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
, do hereby accept the appointment
(Pfe-ase Print or Type Name)
designated above as: Rr Campaign Treasurer. ❑ Deputy Treasurer.
VA9)2,7.z 3 x
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, FAC.
PPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECEIVED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) AUG 0 4 2023
(PLEASE PRINT OR TYPE)
City of Sebastian
NOTE: This form must be on file with the qualifying officer City Clerks Office
before opening the campaign account. OFFICE USE ONLY
?Initial
t Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
4. Telephone 5. Candidate's -Voter Registration #:
(Not required for Qualifying Purposes)
3. Address (include post office box or street, city, state,
zip code)
(Not required for Qualifying Purposes) - Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on
the audio /b�allot as may be used by persons with disabilities (see instructions on page 2 of this form):
i'YEn 1'49nz.
6.Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
V ❑ My intent is to run as a Write -In candidate.
ov
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 2/No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer
10. Name of Treasurer or Deputy Treasurer
12. Mailing Address
7
11. ?' 4
16. 1 have designated the following bank as my
13. City / 14. State
S�JZ/ N'F✓ /�/
[ Primary Depository ❑
17. Name of Bank 18. Address
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19. City �p 20. County 21. State
SG!/JF.7 /idY/r� 2.—A :rn/.eLGiW
Deputy Treasurer
11. Telephone
0-9-9 ) 5,-)3-3ss9'
15. Zip Code
-? j 9. e
Secondary Depository
22. Zip Code
-7 ? -? <e'
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.
23. Date 24. Signature of Candidate
o.e,/oY/23 x
25. Treasurer's Acceptance of Appointment (fill In the blanks and check the appropriate block)
I,S "�� , do hereby accept the appointment
( ease not or Type Name)
designated above as: Campaign Treasurer. ❑ Deputy Treasurer.
t�8"114Ps/2 v� 3 x —
ate Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 07123) Rule 1S-2.0001, F.A.C.