HomeMy Public PortalAboutAppointment of Campaign TreasurerAPPOINTMENT 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.
OM C!TYC _ERKDlf
SEPI2'lS pm 1:q
OFFICE USE ONLY
1. ECK 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)
Copy W,lJrawN D.DIr�eI
3. Address (include post office box or street, city, state, zip
code)
5341°
4. Telephone
(3.C2 ) gy731°1
5. E-mail addre
(ore)/ .c% a��� �, o0,
f0 gm':
Orle*h Ft 3 Z8G3
6. Office sought (include district, circuit, group n mber)
7. If a candidate for a nonpartisan office, check if
� � /A
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
❑ Write -In id No Party Affiliation 7 Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Corey U/, I1;A0, Detio1 et
11. Mailinc, Address
PO /o.)( ' 530
4
12. Telephone
(3352. ) 612e1— -001
13. City
�,/lav-e 3
14. County
, 0 `�;� v
15. State
p_z,
16. Zip Code
32y03
17. E-ma.l address
Corey devldl O9,n4't, CO*.
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19.
ASS,
Name of Bank 1
/, d / 1 /IfnN ��1 �. !
20. Address
,) D /� /
00 f r1 /h if%G. U / vo
21. City
ZAK6 441:ily
22. County
Seth,.A.0 it,
23. State
riort c.
24. Zip Code
3D.14 6
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
ZDK
0q/ I z✓ MS
26. Signature of Candidate
X , ...
27. Treasurer's Acceptance of Appointment (fill in the tanks and check the appropriate block)
I, Co re O Voi e / , do hereby accept the appointment
Y (PlegSe P int or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer.
0`1/ I /ZOt6\ X
Date Signa rti.:„.".__ __- --...„...›,...,------ ----
re of mpaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.