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HomeMy WebLinkAboutGILLIAMS DAMIEN PRE-QUALIFYING DOCSAPPOINTMENT OF CAMPAIGN TREASURER RECE�VEp AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES JAN (Section 106.021(1), F.S.) City o f's ?013 (PLEASE PRINT OR TYPE) CI ty C /erks OMce NOTE: This form must be on file with the qualifying officer before 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. of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Name �.�L_ b4w-s _ code) � -5 S�i'';s't'►�'' �`- ZC S-$ 4. Telephone 5. E -mail address zi �o��vinio @ (v+MtUtSf r�eY 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if �� 3 v�S rt C� T �o �' c applicable: [] My intent is to run as a Write -In candidate. 8. If a candidate fora partisan office, check block and fill in name of party as applicable: My intent is to run as a ❑ Write -in i4 No Party Affiliation ❑ Party candidate. 9. 1 have appointed the following person to act as my 14 Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer C—, 11. Mailing Address 12. Telephone (ke z3 .)S ) 13. City 14. County 15. State 16. Zip Code 17. E -mail address S r �3 w,J aa� .-I ,F ` -3 za 5-g- -k' A o' o roe, 18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address 8 b 21. City ScS��ST 22. County 23. State 4" c, 24. Zip Code '325 58 UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACT TED IN IT ARE TRUE. r 25. Date _ 26. Signatur Candid e , X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, �`�`�` �` (Il' o- 4`� , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer ❑ Dep surer. - 3 v3 X Date Signature of Campifign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 1 Oil 0) Rule 1S- 2.0001, F.A.C. OFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) C�� 3 ?O (Please print or type) C�IYC�%feb estia3 Off, candidate for the office of fj,�s �► `` have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X Signature bfJCandidate Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS -DE 84 (05111) ,#J-e.c - , >^ ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY J qN 3 � Of se 3 �"k's dstis p� n ca "No person shall be eligible to hold the office of council member unless he or she is a qualified elector* in said city and actually continually resided in said city for a period of one (1) year immediately preceding the final date for qualification as a candidate for said office." I, ''- `"-`A ` krl ``�" S , candidate for the office of Council Member, meet the eligibility qualifications to hold office as required in Section 2.02 of the City of Sebastian Charter, above. Signature of dandidate 22 Swor o nd subscribed before me this J/ day of , 2013 Notary Pu State of Florida Exkqe.'� SALLY A. MAID Commission # EE 024350 Expires October 5, 2014 SEAL Balled TM Troy Fan IMVMW 800 W3 7019 *166.032 Electors. - -Any person who is a resident of a municipality, who has qualified as an elector of this state, and who registers in the manner prescribed by general law and ordinance of the municipality shall be a qualified elector of the municipality. Ms- word/election/charter eligibility