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Appointment 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: l Treasurer/Deputy Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) Aretha Janine Olivarez 3. Address (include post office box or street, city, state, zip code) P.O. Box 618685 Orlando, FL 31-644 4. Telephone (407 ) 505-9515 5. E-mail address mti535@yahoo.com 6. Office sought (include district, circuit, group number) Orlando City Commissioner, District 4 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 5:] No Party Affiliation [] Party candidate. 9. I have appointed the following person to act as my ❑ Campaign Treasurer ® Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Adreanna Simons 11. Mailing Address 1641 S. Kirkman Rd 12. Telephone ( 407 ) 575-0685 13. City ORLANDO 14. County orange 15. State FL 16. Zip Code 32811 17. E-mail address adreanna.si©gmail.com 18. I have designated the following bank as my 4 Primary Depository 0 Secondary Depository 19. Name of Bank .v` -fir s ,1-- 20. Address i� c r ..ti 21. City 0r� 1L-4-7 22. County 0 4- el-'—�.er 23. State F' - 24. Zip Code 3 -r'/ 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 0%% 22D/ -s 26. Sig ture of Candidate X 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) Adreanna Simons , do hereby accept the appointment (Please Print or Type Name) designated above as: ❑ Campaign Treasurer 0 Deputy Treasurer. . 6/5 X Date Sianature of Camoaian Treasurer or Deputy Treasurer