HomeMy Public PortalAboutAppointment of Campaign Treasurer (2)APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: Treasurer/Deputy
, Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
Bakari Fuasi Burns
3. Address (include post office box or street, city, state, zip
code)
P.O. Box 551109
Orlando, Florida 32855
4. Telephone
(407 ) 202-6516
5. E-mail address
bakari.burns@gmail.com
6. Office sought (include district, circuit, group number)
City Council - District 6
7. If a candidate for a nonpartisan office, check if
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 No Party Affiliation Party candidate.
9. I have appointed the following person to act as my la
Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Bakari F. Burns
11. Mailing Address
P.O. Box 551109
12. Telephone
( 407 ) 202-6516
13. City
Orlando
14. County
Orange
15. State
Florida
16. Zip Code
32855
17. E-mail address
bakari.burns@gmail.com
18. I have designated the following bank as my 0
Primary Depository Secondary Depository
19. Name of Bank
Fifth Third Bank
20. Address
200 East Robinson St.
21. City
Orlando
22. County
Orange
23. State
Florida
24. Zip Code
32801
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. Sign ire of Candi ate
3/15/2019
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Bakari F. Burns , do hereby accept the appointment
(Please
designated above as:
2
Print or Type Name)
Campaign Treasurer Dep easurer.
3/15/2019 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
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