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Home My WebLink AboutDS DE 9 PPOINTMENT OF CAMPAIGN TREASURER RECEIVED AND DESIGNATION OF CAMPAIGN AUG 16 2024 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) City of Sebastian (PLEASE PRINT OR TYPE) City Clerk's office NOTE: This form must be on file with the filing officer before opening the campaign accourr OFFICE USE: ONLY 1. CHECK APPROPRIATE BOX(ES): 0 Initial Filing of Form ❑ Re -filing to Change: © Treasurer/Deputy © Depository 0 Office ❑ Party 2. Name of Candidate (in this order. First, Middle, Last): 3. Address (Include PO Box or Street, City, State, Zip Code): lease P or Type Name) w I V �.I"Z' t� i t_j-iV4� 5 IloZ3 vs I+ Y- S :FLq y 4. Telephone: 5. Candidate's Voter Registra lion 8: 6. Email Address: (')1i.) 11.E �J�l i .7� i� I N �Q vHC,4 5 i , 1JL�;� (not required for 9�pN�9 Pates) 7. Office Sought (Included circuit, group, or seat ft I 8. a candidate for a nonpartisan office, check the box If applicable; Sep n S'( I A N 1 `- CI , C/ t pv N t l ❑ I intend to run as a Write -In Candidate. 9. N a candidate for 2AMM office, check the box and fill in the name of the party as applicable: I intend to run as a ❑ Wrde-In Candidate. 0 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. 112.Tolophons: 18: 3. Email Address: V,\Iev, �l. a ILi_tV},-5 ( �-72) 1I 3 6L"It) ltittoCFcv�ay,ay�f , NPr 14. Mailing Address: 15. C 16. 17. Zap Code: 11,r23 US I SuI4{ S S cS�Silw� I I:L I�zYS-`2 18. 1 have designated the following bank as my (check appropriate box): ® Primary Depository ❑ Secondary Depository 19. Name of Bank: 20. Address. PrJc 9A0V I �1��51 ?I�� 21. City: 22. Counly: 23. State: 24. Zip Code: C�,giN S (!Vint I t-4.r )'lvlr 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 'EfAT1jtE FACTS STATED IN IT ARE TRUE ix 26. Signatur6 of . di�te: 25. Date: I �' "Z `F /�// 27. Treasurer's Acceptance of Appointment (fill in the blanks and the the appropriate box) I, 7AW�I� 0 - c(1 t L t y} r S (Please Prim or Type Name) ® Campaign Treasurer. 28. Date: 10 Z'-I DS-DE 9 (Rev. 09123) do hereby accept the appointment designated above its: ❑ Deputy Treasurer. 29. Signature Campaign Treasurer or Deputy Treasurer X Rule 15-2.0001, F.A.C.