HomeMy Public PortalAboutAppointment of Campaign Treasurerir
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: his form must be on file with the qualifying
office fore opening the campaign account.
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ORL CITY CLERK
JUL231b R ' :04
USE ONLY
'L OFFICE
1. ECK APPROPRIATE BOX(ES): J(R 71-3/'
Initial Filing of Form Re -filing to Change: Treasurer/Deputy
•
Depository
•
Office
•
Party
2. Name of Candidate (in this order: First, Middle, Last)
Ron GI a SCe f+ Mocosk;
3. Address (include post office box or street, city, state, zip
code) ' 11(j MueC qdo SI-
4. Telephone
(Nd-7 ) 30G-6561
l:ll(`.
5. E-mail address J Or ctri ci(b L I1
RSNI0c-06k:&ir✓Irt; 1,6011
6. Office sought (include district, circuit, group number)
! `CL p r d r 0 (h nc4 C.
7. If a candidate for a nonpartisan office, check if
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
1111
Write -In 12/ No Party Affiliation
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Party candidate.
9. I have appointed the following person to act as my 17 Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
ROhrn(d 56,6HHJr uro ts-i
11. Mailing Address
'1(13
A-toe L 5 `-t
12. Telephone
( 407 ) 3oa---6SE1
13. City l
orlanoto
14. County
Or -c inic.
15. State
f L
16. Zip Code
3aela
17. E-ma'i address
R5/''10..0 :-ie y ,q, ." w,
18. I have designated the following bank as my la Primary Depository [] Secondary Depository
19. Name of Bank
5v✓n Try4
20. Address
LiLI `( L-ctsl- /14;c -L' , A&e
21. City
I
22. County
23. State
4. Zip Code
OG
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
7 - - O 1 5
26. Signature o
X
Candidate
‘,XC 4-411
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, R p v'1A rIA SGo 4 / / V T U S tl ',1 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ puty Treasurer.
7.-- /— 01015 X
Date Signature of Campaign Treasurer or Deputy Treasurer
nc_nr o IDr, 1Ah1m
(
Rules IS_9_nnnl_ F.A.C:.