HomeMy Public PortalAboutAppointment of Campaign Treasurer (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.
_
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OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
✓ Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository U Office 1 1 Party
2. Name of Candidate (in this order: First, Middle, Last)
GARY SIPLIN
3. Address (include post office box or street, city, state, zip
code)
PO BOX 585884
ORLANDO, FLORIDA 32858
4. Telephone
( 407 ) 900-2050
5. E-mail address
gary@garysiplin.com
6. Office sought (include district, circuit, group number)
ORLANDO CITY COUNCIL - DISTRICT 6
7. If a candidate for a nonpartisan office, check if
applicable:
M
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 [./J Campaign Treasurer n Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
GARY SIPLIN
11. Mailing Address
1320 NORTH PINE HILLS ROAD
12. Telephone
( 407 ) 900-2050
13. City
ORLANDO
14. County
ORANGE
15. State
FLORIDA
16. Zip Code
32808
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
20. Address
390 NORTH ORANGE AVENUE
21. City
ORLANDO
22. County
ORANGE
23. State
FLORIDA
24. Zip Code
32801
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
MARCH 5, 2019
26. Signature of Candidate
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, GARY SIPLIN , .- . ereby ac -: e appointment
(Please
designated above as: ./
MARCH 5, 2019
Print or Type Name)
Campaign Treasurer ❑ Deputy re•
X
rer .
Date Signature • ampaig" -_- rer or Deputy Treasurer
3
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.