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Home My WebLink AboutAppt 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 openinq the campaign account. 1. CHECK APPROPRIATE BOX(ES): K Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy RECEIVED AUG 15 1023 City Of Sebastian City Clerk's Office OFFICE USE ONLY Depository ❑ Office ❑ Parry 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, 'i�)Vk1Vtn. (t L,k zip code) 4. Telephone S. Candidate's Voter Registration #: �� (��z)-113�i©-7I (Not required for Qualifying Purposes) (Not required for Qualifying Purposes) - Phonetic spelling for audlo ballot: Prim name phonetically on the line below as you wish it to be pronounced on the and o ballot as may be used by persons with dissbil:tles �e Instructions on page 2 of this fort : - A i —Alt -�� -I _/�► - �- L - i=. �- a -/,A- 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. 8. It a candidate fora partisan office, check block and fill In name of party as appli able: My intent is to run as a �((JI� .ftl2 -t-W S `'u t5o s"rli+v �i-r `t ❑ Write -In ® No Party Affiliation ❑ 1"0vNUL w r Parry candidate. 9. 1 have appointed the following person to act as my © Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Tre urer 11. Telephone D(4 m t—ev., N i L_L_ t 44-w S ( —7 1 Z) -11-3 12. Mailing Address 13. City 14. Skate 15. Zip Code IA S I wsTIHtJ 16. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository 17. Name of Bank 18. Address FOC— Q 15 5Et AST1 rw-) v,71-V D 19. City 20. County 21. State 22. Zip Code ,5 L: Y3 ta-SI 11,,4LI I � S, Vim rL_ 327rj O Q UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 ndi ale g 15. v3 X 25. Treasurer's Acceptance of Appointment (fill In the blanks and check the appropriate block) I, �FkK k �� ` t c-LC do hereby accept the appointment (Please Print or Type Name) designated above as: � Campaign Treasurer. uty Treasurer. X Date Signa4wof Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 07123) Rule 1S-2.0001, F.A.C.