HomeMy WebLinkAboutHill Pre-Qualifying DSDE9, 84 and EligAPPOINTMENT OF CAMPAIGN TREASURER
RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
AUG , 8 2014
(Section 106.021 (1), F. S.)
City of Sebaslicii
(PLEASE PRINT OR TYPE)
City Clerk's Ofric
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
C£CK APPROPRIATE BOX(ES):
Y Initial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy ❑ Depository ❑ Office ❑ Party
2. Na a of Candidate in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
code)
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4. Telephone
5. E -mail address
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6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
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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 0 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 reasurer
11. Mailing Address
12. Telephone
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13. City
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14. C` ty 15. State
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1 16. Zip Code
32IS
17, mail address
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18. 1 have designated the following bank as my [2---P-rimary Depository Secondary Depository
19. Name of ank 20. Address
21. City
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22. County
23. St
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24. Zip Code
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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
26. Signatur of Candidate
C
--- -
27. Treasurer's Acceptance of Appointment (fill in thdItps and check the appropriate block)
\�
I, _ "> , do hereby accept the appointment
(Please Pri or Type Name)
designated above as: Campaign Treasurer ® Deputy Treasurer.
-` X
Date ignature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C.
RECEIVED
SIEP My OF AUG - 8 2014
City of Sebastian
City Clerk's Office
HOME OF PELICAN ISLAND
ELIGIBILITY TO HOLD OFFICE
OF COUNCILMEMBER
Charter Section 2.02 - ELIGIBILITY
"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, - G 2 � • lA - �� , 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.
Signat r 6 of Candidate
Sworn to and subscribed before me this day of fqu qu s +
2014.
tary Public
State of Florida r,,..,,,,,
�► JEArtEM WILLIAMS
' ` = Commission # EE =67
SEAL `" °= Expires February 28, 2015
''R � a�xarrryr,�rr eoa�asro9�
*166.032 Electors. - -Any person who is a resident of a ntunicipality, who has qualified as an elector of this
state, and who registers in the manner prescribed by general law and ordinance o_f the municipality shall be a
qualified elector of the wunicipalh)
A,f.s- ►i,ord/election/cliartea• eligibility
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
gwveS h, Vi-, �
candidate for the office of er ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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Signature of Candidate
Z/,� 12-01�
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)