HomeMy WebLinkAboutAppt of Treasurer PPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JUL - 3 2025
(Section 106.021(1), F.S.) City Of Se
(PLEASE PRINT OR TYPE) City Clerks c)ff/cn
NOTE: This form must be on file with the filing officer before �ffCe
opening the campaign account. OFFICE: USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial 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):
/- /(Pl_ease Prints or Type ��
Name)
CAC
4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address:
(727 g07t,vn.fj, Ahd�a./,saw
(not required for qualifying purposes)
7.Office Sought (include distric , circuit, group, or seat #): 8. f a candidate for a nonpartisan office, check the box
if applicable:
G j' Gd�'� C I ❑ I intend to run as a Write -In Candidate.
9. If a candidate for partisan 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:
C1Arr,St6P1qW
14. Mailing Address: 15. City: 16. State: 17. Zip Code:
7oq l�sfi u�► FZ- 3d% .5�r
18. 1 have designated the following bank as my (check appropriate box): ❑ Primary Depository ❑ Secondary Depository
19. Namq of Bank: 20. Address:
4gCt+=cn� n y /DSO uS 1
21. City: 22. County: 123. State: 24. Zip Code:
S�Sus �r a in s40(l un ��VEkt /A-- L 31�s�
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.
25. Date: 7 _ 2 j 128• Signature of Ca e:
27. Treasurer's Acceptance of Appointment (fill in tX and check the appropriate box)
1, Ch`f�tier tiCj--7n
(Please Print or Type Name)
Campaign Treasurer.
28. Date:
` -
3-
d 5
DS-DE 9 (Rev.
09/23)
do hereby accept the appointment designated above as:
❑ Deputy Treasurer.
29. Signature of Campaign leasuurr Deputy Treasurer
X
�' 5-2,0001, F.A.C.