HomeMy Public PortalAboutAppointment of Campaign Treasurer (3)APPOIN'TMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) I
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: 0 TreasurerIDeputy [7 Depository Office Party
1 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 [7 Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
sherwood A/hn &hogj fr.
11. Mailinn Address 1 12. Tele~hone
code) lbl3 E- Lhbfbb4 P
On4 32B3
4 Telephone
(~0.7 ) 37~-700,
5. E-mail address
,eilp&~Wvd'
6. Office sought (include district, circuit, group number)
A&o+ dd 6'8.d-L
13. City
Ocoee
I 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. I
7. If a candidate for a nomartisan office, check if
applicable:
My intent is to run as a Write-In candidate.
21. City odd
1 25. Date 1 26. Signature of Candidate
14. County
Oraqe
I 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
18. 1 have designated the following bank as my Primary Depository a Secondary Depository
22. County
hal.7~
e~daod A. 6h0& , do hereby accept the appointment
(Pleasvrint or Type Name)
15. State
I="
19. Name of Bank
W&J 60
designated above as: d Campaign Deputy Treasurer.
8 - 30 - 15
Date
20. Address
23. State
FL
I I
DS-DE 9 (Rev. 10110) Rule IS-2.0001, F.A.C.
16. Zip Code
34~
24. Zip Code
32803
17. E-mail address
r~~od)d#@~oL &dm