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.
FEB 27 2019 HH10:O8
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
[EK Initial Filing of Form Re -filing to Change: jJ Treasurer/Deputy ❑l Depository [J Office [] Party
2. Name of Candidate (in this order: First, Middle, Last)
sa.,.. t..4 e/ 34.r.J, e -rotic '
3. Address (include post office box or street, city, state, zip
code)
,7.0. 20 K SS/306
Or/aiuq/o/ �'� 3Z Q :53-„�/Jo 6
4. Telephone
( 4107) V66 -377V
5. E-mail address
si3• 6S,�Qacf co"
6. Office sought (include district, circuit, group number)
/{la y or
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 ❑I Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
%.'4',VJ Qc. T.v�.f
11. Mailing Address
6S"4 % Raja/ TAN fleeef-
12. Telephone
(ft7 )ZZZ-3/O6
13. City
Or(a•Jalo/
14. County
Ora Ale.
15. State
FL.
16. Zip Code
3418/0
17. E-mal address
7-LauerAIR@a04co4
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank
4 X%o M Ea^Ik
20. Address
7/S S., o/dwyN Ad/QN4Q.
21. City
C9rlaAida,
22. County
0ra•ucre
23. State
F.Z.
24. Zip Code
3a6"OS
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR AP •INTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS T IN IT ARE TRUE.
25. Date
o02/427470 / 9
26. Signature of; - didate
x —.,,
27. Treasurer's Acceptance of Appointment (fill in the blanks a check the appropriate block)
I, nAAe.AA.r (*Al et ..Z _ , do hereby accept the appointment
(Please Print Type Name)
designated above as: Campaign Tre-surer
OR A7/RO/ 9
-!e.uty1 re, u
Date Signature of :mpaign Tr surer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.