HomeMy Public PortalAboutAppointment of Campaign TreasurerAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021 (l), F.S.)
I (PLEASE PRINT OR TYPE) I
( 2. Name of Candidate (in this order: First, Middle, Last) 1 3. Address (include post office box or street, city, state, zip
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
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6. Office sought (include district, circuit, group number) 1 7. If a candidate for a nonpartisan office, check if
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: TreasurerlDeputy Depository Office 0 Party
applicable:
My intent is to run as a Write-In candidate.
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d 328103
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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 [7 Party candidate.
4. Telephone
person to act as my Campaign Treasurer Deputy Treasurer
5. E-mail address
1 1. Mailing Address 1 12. Telephone
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13. City 1 14. County 1 15. State I 16. Zip Code ( 17. E-mail address
I 19. Name of Bank
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20. Address 1 Z'cay E. G(J Dy,
18.1 have designated the following bank as my Primary Depository 0 Secondary Depository
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25. Date 1 26. Signature of Candidate
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21. City
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Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
h - p1&fl 1 %>%Js~c~ , do hereby accept the appointment
(Please Print or Type Name) 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.
22. County ~~
designated above as: Campaign Treasurer
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Date Wature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 1011 0) Rule 1 S-2.0001, F.A.C.
23. State
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24. Zip Code
3 2803