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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) GT.in l A I�H Ods�- t 1 C•� ' L Z 5e, \0 4. Telephone 5. E -mail address (W-11V ) 4�L�- JL�`r�1 ��✓ic�t��t (�{c�ai.�CtC.GGf+�1 t 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if � (2 C QUVVCA \ 2i�t ? 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 RO ) Z "j4- 52 1/b 13. City G� &)C,� �c�� 14. C` ty 15. State C- 1 16. Zip Code 32IS 17, mail address Z��1>w m allDU rr� 18. 1 have designated the following bank as my [2---P-rimary Depository Secondary Depository 19. Name of ank 20. Address 21. City fi S 'k,�L - 22. County 23. St L 24. Zip Code qS 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. 0W %M 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)