HomeMy WebLinkAboutAppt of Treasurer PPOINTMENT OF CAMPAIGN TREASURER P,ECE�VED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JUG 29 Zp25
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) C:kv of Seb O6axcE
NOTE: This form must be on file with the filing officer before Clt`l
C)efk
opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Ly'Initial Filing of Form ❑ Re -fling 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)
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4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address:
ypnot required for qualifying purposes)r 0407
7. Office Sought (include district, circuit, group, or seat #): 8. f a candidate for a nonpartisan office, check the box
/ /+ if applicable:
q C f Go c( n� I ❑ I intend to run as a Write -In Candidate.
9. If a candidate for partisan office, chlack 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/ epu%ty Treasurer:
12. Telephone: 13. Email Address:
14.//Mailing Address:
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15. i 16.. rState: 17. Zip Code:
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18. 1 have designated the following bank as my (check appropriate box): E Orimary Depository ❑ Secondary Depository
19. Name of Bank:
�ity:
20. Address:
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21.
22. C/ounty: 23. State: 2/4.. ^Z/ip Code:
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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: -?/0- 9/a s
26. Signature of Candidat
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
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do hereby accept the appointment designated above as:
(Please Print or Type Name)
Campaign Treasurer.
❑ Deputy Treasurer.
28. Date:
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29. Signature of Campaig easurer or Deputy Treasurer
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DS-DE 9 (Rev. 09/23)
Rule 1S-2.0001, F.A.C.