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.
DEC 52018 Pp 4:33
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
1i r. Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
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3. Address (include post office box or street, city, state, zip
code) D.DO`, (Prlr133k-
4. Telephone
(3a) ).(g'.3D-9(oala
5. E-mail address
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6. Office sought (include district, circuit, group number)
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C l an Lt D �i t3 1"lCcl� c (0 i,5+r c e,..\- 1
7. If a candidate for a nonpartisan office, check if
applicable:
0 My intent is to run as a Write -In candidate.
8. If a candidate for a .artisan office, check block and fill in name of party as applicable: My intent is to run as .a
Write -In
•
No Party Affiliation Er_ n� � a0 Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
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DC 1c R. 3a.%(o7
12. Telephone
(3al) c630 -Q403(40
13. City
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14. County
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15. State
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16. Zip Code
3a% (09
17. E-mail address
18. I have designated the following bank as my ®' Primary Depository ❑ Secondary Depository
19 Name of Bank
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20. Address
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21. City
UNDER PENALTIES OF PERJURY, I DECLARE
DESIGNATION
22.
OF CAMPAIGN
County
THAT I HAVE READ THE FOREGOING
DEPOSITORY AND THAT
23. State
FORM FOR APPOINTMENT OF CAMPAIGN
THE FACTS STATED IN IT ARE TRUE.
24. Zip
Code
TREASURER AND
25. Date
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26. Signature of Candidate
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27. Treasurer's
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, Senn
Acceptance of Appointment (fill in the blanks and check the appropriate block)
t_._ , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Er Campaign Treasurer ❑ Deputy Treasurer.
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of Campaign Treasurer or Deputy Date Signature p y Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.