Loading...
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) 0-......., 4- / f . Div 3. Address (include post office box or street, city, state, zip 7,--elade 4.0...4.4444.4.0...4.4444.77--.04,„ / code) z4,43.5,- 4. Telephone ll�� ( f' 7 )S72 -ered 5. E-mail address stz-A ssie c ca.••.. Qr/a.ikacy �C. 3 2 O.S � 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check If 65•- 0--; /j,.6 0J er- De i ,r t t.74 6 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 Erio Party Affiliation • Party candidate. r 9. I have appointed the following person to act as my 0 Campaign Treasurer Er Deputy Treasurer 10. Name of Treasurer or Deputy Treasurerer-s 11. Mailing Address Zeds re- a v4e w. 77G.: / 12. Telephone (ed7 ) d'702 -4s-%3' 13. City or%a...JA 14. County di -43, 02 15. State /G 16. Zip Code JZPQ..t~ 17. E-ma'I address S47 -416r CaRcao/ CO 4.1,--.. 18. I have designated the following bank as my p• --Primary Depository ❑ Secondary Depository 19. Name of Bank 1 4 )fi .. #''� 34%,%,) 4- 20. Address 714 fo c..7€ C04/4410v wy,v ,4€,' w e_ 21. City Qr t C 1 22. County or -0, -.:ye 23. State A -G 24. Zip Code 113.Z,f)DS" 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 STA IT ARE TRUE. 25. Date S/6/g CV -r- 26. Signature of ate 1 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, �Q 1.1-"i CA. e_/ 4• or .,f , do hereby accept the appointment (Please designated above as: / ZG /.S- Print or pt- Name) ■ Campaign Treasurer Er--- u easurer X Date Signature Campaign Treasurer or Deputy Treasurer .. ------_ DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.