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HomeMy WebLinkAboutAdams Pre-Qualifying Docs - DSDE9,84&EligAPPOINTMENT TREASURER �i'�0��1/40 AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) City 2Qf� o C/ C /erk'sbpan (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): X) Initial Filing of Form Re- filing to Change: C] Treasurer /Deputy ❑ Depository ❑ Office F] Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Jerome Michael Adams code) 901 Roseland Rd., Sebastian, FL 32958 4. Telephone 5. E -mail address (772 ) 924 -1259 adams- 12 @att.net 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Councilmember applicable: ❑ My intent is to run as a Write -In candidate. 8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a Write -In ❑ No Party Affiliation Party candidate. 9. 1 have appointed the following person to act as my 0 Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Jerome Adams 11. Mailing Address 12. Telephone 901 Roseland Rd. ( 772 ) 924 -1259 13. City 14. County 15. State 16. Zip Code 17. E -mail address Sebastian Indian River FL 32958 adams- 12 @att.net 18. 1 have designated the following bank as my QX Primary Depository Secondary Depository 19. Name of Bank 20. Address PNC Bank 1993 Sebastian Blvd., 21. City 22. County 23. State 24. Zip Code Sebastian Indian River FL 32958 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 FACTS STATED IN IT ARE TRUE. 25. Date -711114 26. Signat re of Candidat X 27. Treasurer's Acceptance of Appointment (fill in t e blanks and check the appropriate block) 1 Jerome Adams do hereby accept the appointment (Please Print or Type Name) designated above as: X❑ Campaign Treasurer Deputy Treasurer. 7/04 X Date ig ature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C. STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 1, Jerome Adams , candidate for the office of Councilmember ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X Signature of Candidate 71i h4 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 (05/11) ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY c;JU� ° ! aDl Y Of k ty Cis o�c� "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, J E11F01v E ADA10S , 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. L,17,ature of Can d-idate Sworn to and subscribed before me this day of 2014 1G� SALLY A MAIO X. 4 Notary P U IC = `1 - commission # EE 024350 ry- o, Expires October 5, 2014 State of Florida ` BMW T UT�Fen 705 SEAL *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 t