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.
O CITYCLERK
E
JAN 6' 9 pHe1:4
OFFICE USE ONLY
1.
HECK 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, L st)
1760-k sh 32-k- h 4 y\ (Pctt\(;-ao
3. Address (include post office box or street,
code) 0\ t m h A e s`{zt S QL',
0 it (a 140 t— 32 603
city, state, zip
4. Telephone
(4-69) ?q C -7z(1v
5. E-mail address
erti 5)102;14 r `r l i0D -(jci'
6. Office sought (include
Or Ian `B o e
district, circuit, group
c ( Dis..1\i
6)14 AC('
number)
1
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 Treasurer or Deputy Treasurer
LIVI \ Aicitquoo
11. Mailing Address
0062 6 eMKL/4K e Si
12. Telephone
4)7)&17-232-i
13. City
D Itnc6
14. County
U)2ectt\hr
15. State
FI—
16. Zip Code
3Z3DS
17. E-ma'l address
Soos'yine..._jc; (5! hdfm . c1)nt.
18. I have designated the following bank as my O Primary Depository ❑ Secondary Depository
19. Name of 11 or
r I 1 _ Cod.
CCvt-1rej11oritfclA c (4(.41DrS ,.(- (1A111-\
20. Address
9Ltrl
( I23.
1
A I 4 i(S 'l1/'2Vti,i�
NI.
21. City
Gv- (unto
22. County
Qrzt n v.__
24. Zip Code
32-803
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 FACT STATED IN IT ARE TRUE.
25. Date
26. Signalit)re of andidate
i I
27. Treasurer's
I,
Acceptance of Appointment (fill in Hie blanks and check the appropriate block)
) i,1I1 j IN / ] . n I (A)b , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
115'POI X
Date nature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.