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.
ORE_CITYC LFR Dl
DEC1718 P o: n
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
IA Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
aQ 1 +t) ti+o OCI Ica
3. Address (include post office box or street, city, state, zip
code)
46 U s I c► end iZd .
riard& rY 1
3
4. Telephone
(113 )g -cl8 �
5. E-mail address
�t
`J
,I.«,
6. Office sought dt (include
Y 1� 0 Crkj
trict, circuit, grnlip member)
1Cib1
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 forapartisan 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 Treasurer or Deputy Treasurer ,{
ea ni-ri riaQ Ccks a t�,{
11. Mailing Address ()
4ig L- • A Nceoquik bnk 4 (c / 9
12. Telephone
(y3 ) 21Q - (/ ?&
e13`. ►City
AllamKd\e SP6ri. i�
14. `County _
5011WiG I`Q
15. State
rC.
16. Zip Code
L3.�®\
17. E-mail _a`ddresss
(sabO I`t�.i@ V'r CIr 1 •C G0\
18. I have designated the following bank as my ❑ Primary Depositor ❑ SecdTSdar?Depository
19. Name of Bank
0_,Feerech+ Linton
20. Address
q ti`
-
- ' Wills A‘A .
21. City
bt /Cm cb
22. i,ounty
thrcIN0Q
23. State
f LoY• I d c
24. Zip Code
5? 03
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVi 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
11/11-/
26. Sign re of Candi
X ,
27. Treasurer's Acceptance of Appointment (fill ' the blanks and chec the appr prl to block)
I, Ifl ifs solb42( eby accept the appointment
a
(Plea
rint or Type Name)
Deputy Treasurer.
designated
IC/
above as:
)71- /(;)01?
0
Campaign Treasurer ❑
X
Date Si u e o ampal
a eputy Treasurer
Rule 1S-2.0001, F.A.C.
DS -DE 9 (Rev. 10/10)