HomeMy Public PortalAboutAppointment of Campaign Treasurer (2)APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
I (PLEASE PRINT OR TYPE) I
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES): a Initial Filing of Form Redling to Change: a TreasurerIDeputy Depository Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last) 1 3. Address (include post office box or street, city, state, zip
I 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. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer ~rfi~~ut~reasurer
code)
/&I3 2? &'~lk4sfh.++iL
d?!, FL 32g.03
Net/ 6-c P2m k. AKA fa/ P~JM
4. Telephone
( yo7 ) 376 -7000
5. E-mail addres;
na>p&,@hu.-
6. Office sought (include district, circuit, group number)
. .
k2-2- =
7. If a candidate for a nonpartisan office, check if
applicable:
My intent is to run as a Write-In candidate.
1 1. Mailing Address
/ E. CLl.r;L.Js~p
1 25. Date 1 26. Signature of Candidate I
12. Telephone
13. City
04
19. Name of Bank wQ& +o
8/11 -IT 1-
27. Treasurer's Acceptance of Appointment (fill in the blanks anxheck the appropriate block)
20. Address
a'f3y E. cb(& h..
1, p~ul &-L~LS~ , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
18. 1 have designated the following bank as my a Primary Depository 0 Secondary Depository
8- 31-/5 X
Date Signature of Campaign Treasurer cfbeputy yreasurer I
14. County
G?~
DS-DE 9 (Rev. 10110) uule IS-2.0001, F.A.C.
16. Zip Code
3L@3
15. State
B
24. Zip Code
3=3
21. City O~R
17. E-mail address - ~e;id* a hU.-
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 23. State
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