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.
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OFFICE USE ONLY
1.
0
CHECK 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, Last)
Aretha Janine Simons
3. Address (include post office box or street, city, state, zip
code)
P.O. Box 550415
Orlando, FL 32855
4. Telephone
( ci-c7 ) 505-9515
5. E-mail address
arethaformayor@gmail.com
6. Office sought (include district, circuit, group number)
City Mayor
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
X
No Party Affiliation Party candidate.
9. I have appointed the following person to act as my X
Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Porfirio Agramonte
11. Mailing Address
P.O. Box 550415
12. Telephone
( 407 ) 970-2326
13. City
Orlando
14. County
Orange
15. State
FL
16. Zip Code
32855
17. E-mail address
arethaformayor@gmail.com
18. I have designated the following bank as my
X
,
Primary Depository ❑ Secondary Depository
19. Name of Bank
Suntrust
20. Address
4582 S. Kirkman Road
21. City
Orlando
22. County
Orange
23. State
FL
24. Zip Code
32811
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.
25. Date
11-27-17
26, Si. a ' re of Can. id. -
X / ' (j1,,-e,,��
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Porfirio Agramonte , do hereby accept the appointment
(Please
designated above as:
11-27-17
X
Print or Type Name)
Campaign Treasurer Deputy Treasurer.
X
Date Signat e of Campaign Treasurer or Deputy Treasurer