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Home My Public Portal AboutAppointment 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. .-- CITYCLFRK FEB'5 4 PO ::. OFFICE USE ONLY 1. El 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) �A /. atir0 z--- • C/2-7"./AZ. 3. Address (include post office box or street, city, state, zip code , /. j 47/C.4.0:-.97"...577 4. Telepho (� - 1) 8 / 5. E-mail ddress . zizil9 q._c_ems-/ O/ 6,4,t/0/ �L 3z 803 6. Office sought (include district, circuit, group number) 7 et:),t.f",;o5S;e:/\ '-� / jar ,L 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 ❑ Write -In ❑ No Party Affiliation ❑ Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Name of reasurer or Deputy reapialr4,-4- 11. Mailing Address /.�/ . / C --.S 7 �s'=7 12. T lephone ( ex, .z 13. City Ode -04.-00 1 County ,1_,1"i0&"-• 15. State /- 16. Zip Code 3Z8©3 17. E-mail address 18. I have designated the following bank as my 1Z Primary Depository ❑ Secondary Depository e of Bank 19),4MJ;A/i 74 r7, �/%0,\/ 20. Address /3S— . C/7 -, 4 eiL, 21. City - G4cA, 0o 22. unty (/�4A4 . 23. State . 64-gr. 24. Zip Code 32- o / 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 I ARE TRUE. 25. Date ,z,4 ZO/ 26. S. ! r/.j a didate - X 27. Tre surer's A cept e of Appointment (fill in th:. blanks and check the appropn te b • ) I, Q,44l /� "� , do kept the appointment (Please Print or Type Name) designated above a : Z Campaign Treasurer ❑ Deputy Treasurer. . 4- z c /7 X Date Signature of ampaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) uie 15-L.0001, I .A.G.