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
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