HomeMy Public PortalAboutAppointment of Campaign TreasurerFEB 12019 f01O: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)
Scrn Nucy\ Pger'k . AWQF LAer4
4. Telephone 5. E-mail address
mckLy muddy @
am�pu l • Corn
6. Office sought (include district, circuit, group number)
(90- ) -c c .
Makijor d dr lando
3. Address (include post office box or street, city, state, zip
code)
P.o • \)05/. i-"Ld O
car \aInddo,
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
Q Write -In No Party Affiliation
9. I have appointed the following person to act as my [Campaign Treasurer ❑ Deputy Treasurer
Party candidate.
10. Name of Treasurer or Deputy Treasurer
Carr (Ce c u c COI
11. Mailing Address
2 P tne_ i e C -
13. City 14. County
PoA rnorl\e. Dr4- ' Y\ C\O\ e
18. I have designated the following bank as my
15. State
16. Zip Code
12. Telephone
(°tok) 4(Q1 -- T6
17. E-mail address
C '`dv�C a)r Q
Primary Depository ❑ Secondary Depository
19. Name of Bank
otc.c.ck k PROS -
21. City
uu,c\ter R;xr \L
22. County
c -Or\• �.
20. Address
' 1 . Marne 1\vd . - \5c
23. State
24. Zip Code
321- al
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
X 4 c,()
27. Treasurer's Acceptance of Appointment (fill in the blanks Ad ch k the appropriate block)
Canoes e Cx au rd
designated above as:
Date
(Please Print or Type Name)
Campaign Treasurer
, do hereby accept the appointment
❑ Deputy Treasurer.
dap _.;A
nature of Campaign Treasurer or D ty Treasurer
Rule 1S-2.0001, F.A.C.
DS -DE 9 (Rev. 10/10)