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
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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