HomeMy WebLinkAboutDS DE 9 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 filing officer before
opening the campaign account.
1. CHECK APPROPRIATE BOX(ES):
RECEIVED
JUL 5 2024
City Of Sebastian
,itV Clerk's Office
OFFICE USE ONLY
52'lnitial Filing of Form ❑ Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last): 3. Address (include PO Box or Street, City, State, Zip Code):
(Please Print or Type Name)
Ve.l q In (e hole l7 iXon
-1( b ue Island S-�,
S2bas-Han , F L 3Z9S8
4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address:
(-712 ) 14 5 3 -5850 lly2g3975 L/Q-I I @v0l dixor) .C_0r%-)
(not required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #): 8. f a candidate for a nonpartisan office, check the box
SP-baS-H cup e l N COtA n C l� if applicable:
❑ I intend to run as a Write -In Candidate.
9. If a candidate for pip office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write -In Candidate. ❑ No Party Affiliation Candidate. ❑ Party candidate.
10. 1 have appointed the following person to act as my: [.'Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
I Pn1 Lj N 17iY-0 n (1-72 )453-s850 ��t(y@vote�eilyd(xanca
14. Mailing Address: 15. City: 16. State: 17. Zip Code:
-71 Slue 1Sland 3+ Sebas+io_n I FL 32qS8
18. 1 have designated the following bank as my (check appropriate box): 9Primary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
Seac0Q5 I M o (2ose.lard Zed•
21. City: 22. County: 23. State: 24. Zip Code:
Se.baS-E-iar (=t_ 32GSF3
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
26. Signature of Candidate:
25. Date: J u l y S r 2 2 v I /n'
27. Treasurer's Acceptance of Appointment (fill in the blanks and c k the appropriate box)
I, iJ N - � NJ ( n do hereby accept the appointment designated above as:
(P egse Pdnt or Type Name)
KrCampaign Treasurer. ❑ Deputy Treasurer.
/ 29. Signature of Campaign Treasurer or Deputy Treasurer
za. Date: U Iy 5 2- p 2 1 X CS�X X �- n.
DS-DE 9 (Rev. 09/23) (I Rule 1S-2.0001, F.A.C.