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HomeMy WebLinkAboutIovino Pre-Qualifying Docs - DSDE9, 84 and EligAPPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN RECEIVER DEPOSITORY FOR CANDIDATES AUG - 7 2014 (Section 106.021 (1), F.S.) PLEASE PRINT OR TYPE ( ) city Sebastian City Clerk's Office NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. C}IECK APPROPRIATE BOX(ES): Initial Filing of Farm Re -filing to Change: ❑ TreasuredDeputy Depository ❑ Office ❑ Party 2. Name of Candidate (in this order. First, Middle, Last) 3. Address (include post office box or street, city, state, zip (2 V 1 ✓I t`% code} 4. Telephone 5. E -mail address (77) SY�IU 73 /��ifA� vl.;de / %sues 6. Office sought (include district, circuit, group number) 7. If a candidate for a non pa san o Ice, c e k if L ! L-- 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 E] No Party Affiliation ❑ Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer 11 12. Telephone (TI' - ) 1? 15. State 16. Zip Code 17. E -mail address Jac_ 3,)9 1 18. I have designated the following bank as my 0'r Primary Depository ❑ Secondary Depository 19. Name of Bank M1AtiN1 EtJ�- 20. Address Sabo Nk- DPIVIZ V8 3) --V 21. Cihi 22. County 23. S e 24. Zip Code UNDER PENALTIES OF PERJURY, I DECLARE THAT[ 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 6 26. o Candidate c� ) 2tur v 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1, ^i �, (Z/ /-) &-,� , do hereby accept the appointment (Please Print or Type Name) designated above as. Campaign Treasur r Deputy Treasurer. Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10110) Rule 'IS- 2.0001, F.A.C. MYOF EOk T" HOME OF PELICAN ISLAND ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY �EGEIVED AUG T 2014 City pf Sebastian city clerk's office "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." , , f f- : 0 V /,)c) , 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 Candidate Sworn to and subscribed before me this day of 20J 4. 1 Notory Public State of Florida =* My COMMISSION N EE 865879 EXPIRES: !{ptil 27, 2017 No ° i is a resident of a municipality, who has qualified as an elector of this state, and who registers to 17777 prescribed by general law and ordinance of the municipality shall be a qualified elector of the municipality. Ms- wordlelection /charter eligibility STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) candidate for the office of r j a �/ 6 / have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. x LQ�V� 0�j Signature of Candidate Dat 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). D5 -DE 84 (05 111) II ' i c.+ P4\3-D W f s�( MPS NTIII,r\j 1%