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HomeMy WebLinkAboutGilliams DSDE9APPOINTMENT OF CAMPAIGN TREASURER RECEIVED AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES SEP — 3 2014 (Section 106.021 (1), F.S.) City of Sebastian (PLEASE PRINT OR TYPE) 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 Ctf APPROPRIATE BOX(ES): Initial Filing of Form Re- filing to Change: ❑ Treasurer/ Deputy © Depository ❑ Office ❑ Party 2. Name of Candidate ' his order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip � w1,-f yr ( L_ L_ I vl,.w S code) I V Z 3 U S t4w/ ^ Sc�va�S 1 t`40 --� 4. Telephone 5. E -mail address ( ''1711- )--� X 3 C l �( 14 Wx I c e 60 vo- C k A,� 7! jYie'l 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if (�;E f3 iS T `� �' �1 L 1 (�c3ial�C t applicable: ❑ My intent is to run as a Write -in candidate. 8. If a candidate for a zIp rtisan 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. l have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer lciwt..e v. —L LL_ �__L S 11. Mailing Address 12. Telephone t U-I- v S I t �,� c �U --1-1 `1 ( Z) L� 13. City 14. ,County 15. State 16. Zip Code 17. E -mail address Z 18. 1 have designated the following bank as my [�` Primary Depository 0 Secondary Depository 19. Name of Bank 20. Address aJL- U S 21. City Ai 22. County f �. c!L viI -s ,F�'�J -4 23. State �c� 24. Zip Code 32-1 S f— 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 FAFS-STATE.I IN IT ARE TRUE. 25. Date 26. Signature of andidate 9 x 27. Treasurer's Acceptance of Appointment (fill in the blanks and ch k the appropriate block) 1, `•`� ` do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer Deputy Treasureyr. X Date Signature of Campaign Treas re or Deputy Treasurer DS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C.