HomeMy WebLinkAboutAppt of Treasurer PPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JUL 29 2025
(Section 106.021(1), F.S.) City cif (PLEASE PRINT OR TYPE) City e Sebastian
NOTE: This form must be on file with the filing officer before Y C/rk s Office
opening the campaign account. OFFICE: USE ONLY
1. CHECK APPROPRIATE BOX(ES):
LV 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):
(Please Print or Type Name) ,/ ,
elep one: 5. an ii9ate s oter Registration #: 6. Email Address:
(��z) V93 - 3 (not required for qualifying purposes) L��J_
7. Office Sought (include distric , circuit, group, or seat #): 8. a candt ate for a nonpartisan office, check the box
if applicable:
��r Lyx' ElI intend to run as a Write -In Candidate.
9. If a candidate for oartis�ann office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write -In Candidate. &I 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:
14. ai in A ress: 15. Ci 16. S a�e: 17. Zip Code:
9 P
18. 1 have designated the following bank as my (check appropriate box): D.? PrimaryDepository ❑ Secondary Depository
19. Name of Bank: 20. Address:
i
21. City: 22. County: 23 State: 24. Zip Code:
q
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.
Signature26.
Candidate:
25. Date: D 1/�
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
I,�>/}:,�, G l�/�5 do hereby accept the appointment designated above as:
(P ease Print or' ype Name)
LJ✓ Campaign Treasurer. ❑ Deputy Treasurer.
129 Signature of Campaign Treasurer or Deputy Treasurer
28. Date: 0/% .Z9l_�d,-).'7
DS-DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.