HomeMy Public PortalAboutAppointment of Campaign Treasurer1-113 t1j1U;
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.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository 0 Office
2. Name of Candidate (in this order: First, Middle, Last)
Sct.i f ,�Q P"NiQm ,,r;ticSpr
4. Telephone 5. E-mail address
(qa7 ) 4/ 3779 S NGSZ.Q-4 cow
6. Office sought (include district, circuit, group number)
Party
3. Address (include post office box or street, city, state, zip
code) 0 8d?C' ss/306
crfe /vct/o, tcL 3.28SS-4344,
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 partisan office, check block and fill in name of party as applicable: My intent is to run as a
Party candidate.
Write -In n No Party Affiliation
9. I have appointed the following person to act as my ❑ Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
13.Cit
14. County
18. I have designated the following bank as my
19. Name of Bank
AK.
e o
21. City
r 161/04
22. County
15. State
er-dol 4t„
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.
16. Zi Code 17. E-mail address
Sett,ZW 4,0 CO g4A
P Primary Depository ❑ Secondary Depository
1 20. Address / /// �p ,p
7/5 So 6ofc/ .yia! A1/14.9%6AG
24. Zip Code
23. State
25. Date
492747/RO/7
27. Treasurer's Acceptance of Appointment (fill in the blanks a d check the appropriate block)
26. Signature o4 didate
designated above as:
(Please Print or T Name)
Campaign Treasurer
oa/A 7/R 0/
Date
, do hereby accept the appointment
De! asurer.
ignature of Ca paign Treasurer or Deputy Treasurer
Rule 1S-2.0001, F.A.C.
DS -DE 9 (Rev. 10/10)