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.
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OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
✓❑ Initial Filing of Form Re -filing to Change: n Treasurer/Deputy ❑ Depository U Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
GARY SIPLIN
4. Telephone
( 407 ) 900-2050
5. E-mail address
gary@garysiplin.com
3. Address (include post office box or street, city, state, zip
code)
PO BOX 585884
ORLANDO, FLORIDA 32858
6. Office sought (include district, circuit, group number)
ORLANDO CITY COUNCIL - DISTRICT 6
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 n Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
GARY SIPLIN
11. Mailing Address
1320 NORTH PINE HILLS ROAD
13. City
ORLANDO
14. County
ORANGE
15. State
FLORIDA
16. Zip Code
32808
12. Telephone
( 407 ) 900-2050
17. E-mail address
gary@garysiplin.com
18. I have designated the following bank as my
Primary Depository ❑ Secondary Depository
19. Name of Bank
BANK OF AMERICA
21. City
ORLANDO
20. Address
390 NORTH ORANGE AVENUE
22. County
ORANGE
23. State
FLORIDA
24. Zip Code
01
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM F PPOINTMEN�F AMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FAC ED IN IyA E TRUE.
25. Date
MARCH 5, 2019
26. Signature
x
27. Treasurer's Acceptance of Appointment (filLjp blanks anc-eheck the appropriate block)
GARY SIPLIN
(Please Print or Type Name)
designated above as:
MARCH 5, 2019
Campaign Treasurer
x
Deputy rer.
ereby ac ae p ointment
Date
Signature • ampaig - - rer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.