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Home My Public Portal AboutAppointment of Campaign Treasurer (3)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: 4 Treasurer/Deputy El Depository Office ■ Party 2, Name of Candidate (in this order: First, Middle, Last) 1kn W 17 Dyer- TR, AKA j y 0 tier l 3. Address (include post office box or street, city, state, zip code) P ©, S0 -K. -V deg 04:4 -►44149/ 3 2."1 4, Telephone ( ) 5. E-mail address 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: is 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 [l Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer gi Deputy Treasurer 10. Name oi Treasure(( or Deputy Treasurer tAid7.4-N- ..le in K t n cr.S J 11. Mailing Address /o 6 L v czAr,d Si-- 12. Telephone ()fin ) 9,9.7 30gq 13. City co~ /Cr rm t 0 14. County �ti .vti l 15. State rc- 16, Zip Code 3 z e-o� 17. E -ma I address 1 jj q 4.6 i(ereft 18. I have designated the following bank as my [] Primary Depository E] Secondary Depository 19. Name of Bank 20. Address 21. City 22. County 23. State 24. Zip Code 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. Signatu of Ca 'd 400 X 27. Treasurer's Acceptance of Appointment (fill in the blanks and ch k t appro late block) I, 4 Y] O /r7 S , do hereby accept the appointment (Pleae designated above as: 1/407/5 Print or Type Name) 111 Campaign Treasurer X Deputy Treasurer. / Date Si ure of ampaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.