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.
RECEIVED
JUN -1 2023
City Of Sebastian
City Clerk's office
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository
2. a7off Candidate (I this order: First, Middle, Last)
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4. Telephone 5. E-mail address
c77a > 2b5-5�19� rrr,eg4rI,.J.,- m,i�,cflor
6.Office sought (include district, circuit, group number)
,se-/ 6?�� 4>1 Ci�� �OZ(nc-
OFFICE USE ONLY
❑ Office ❑ Party
3. Address (include posit office box or street, city, state, zip
code)�50 ��1�'jS7 ,afigG-G
_ ,e44J1'9n, Fl- .3a95a
7. If a candidate for a nonpartisan office, check if
applicable:
❑ My intent is to run as a Write-in candidate.
6. 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 Q__`Campaign Treasurer ❑ Deputy Treasurer
10. N6 o�Treasurer C r 4, Y t 74 rarer
11. Mailing Address
d!/ TL !l
13. City P ) 14. Q S�/9V1 � 4r nk/ 15. State 116. Zip
95
18. 1 have designated the following bank as my [Primary Depository
12. Telephone
(??a)
17. E-maqail address f
❑ Secondary Depository
19. NaSme of Bank 20. Address 1 y/n
Je..g60q_S %//0 �Oie /qnd leo4,
21. City JJ 22. Corrnty 23. State 24. Zip Code
5e L]as�•4w\ �n9,.an 4vt.r t<4 �3I Q5,zp
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. Date6/l ) 1 vJ 3 v Si7,a didate
/ '/ &1-41
27. /I Treasurer cc1ept nce of Appointment (fill in the blanks and check the appropriate block)
I, /J O { / C �V 7 14 r do hereby accept the appointment
(Please Print or Type Name)
designated above as: EB"Cempaign Treasurer. ❑ Deputy Treasur
ate Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
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.
RECEIVED
AUG 0 4 2023
City of Sebastian
City Clerk's Office
1. CF}ECK APPROPRIATE BOX(ES):
rInitial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy
2. Name of Candidate (in Ais order: First, Middle, Last)
4. Telephone 5. Candidate's Voter Registration #:
/oy-66S-6-g9
(Not required or Qualifying Purposes)
OFFICE USE ONLY
❑ Depository ❑ Office ❑ Party
3. Address (include post office box or street, city, state,
zip code)
(� So &l s � �I gCC
�/_ 4 95e
se-/ 4s�, q Y7/
(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 ballot as may be used persons with disabilities ee lost lions on gag of this orm):
6.Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
�%/ ❑ My intent is to run as a Write In candidate.JTt (.c�LI �C.I�
8. If a candidate fora Partisan offic 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 U Campaign Treasurer ❑ Deputy Treasurer
10. N�ar�p� of reasurerGr De uty TreasurerY, (7 Telephone
12. Mailing Ad ress 13. City 14. State 15. Zip Code
l 50 &/(/ s-� 7e f ✓� C-c '4is / � n rL 2 r� 95f
16. I have designated the following bank as my Primary Depository ❑ Secondary Depository
17. Name of Bank {/ 18. Address
SC 4�.oq t / /l �[J �S /AA /\ O
19. city// � 20. Cou/J11ff(111t {/���'%%.� 21. State 22.�Zip
Code /t'
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. Date24. Signature o Can idati� G✓/L�"� ` /;
25. Treasurer's cceptancg of Appointment (fill in the blanks and check the appropriate block)
✓� / q h do hereby accept the appointment
(Please Print or Type Name)
designated above as: Q ampaign Treasurer. G, i��/ A" Deputy Tre ur
Date Signature f Campaign Treasurer or Deputy Treasurer
DS•DE 9 (Rev. 07123) Rule 1S.2.0001, F.A.C.