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.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
E Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
Cynthia Harris
3. Address (include post office box or street, city, state, zip
code)
P.O. Box 608837
Orlando FI 32860
4. Telephone
( 407)502- 1'132-
5. E-mail address
shajade@hotmail.com
6. Office sought (include district, circuit, group number)
City Commissioner District 5
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
j
Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Jennifer Somers
11. Mailing Address
7175 Hiawassee Oaks Dr
12. Telephone
( )
13. City
Orlando
14. County
Orange
15. State
FI
16. Zip Code
32818
17. E-mail address
18. I have designated the following bank as my FA
Primary Depository ❑ Secondary Deposit cry
19. Name of Bank
Wells Fargo
20. Address
3900 Silver Star Rd
21. City
Orlando
22. County
Orange
23. State
Florida
24. Zip Code
32808
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
11/14/2016
26. Signat of Ca didate
v % f
27. Treasurer's Acceptance of Appointment (fill in the nks and check the appropriate block)
I, Jennifer Somers , do hereby accept the appointment
designated above a
(Please Print or Type Name)
Campai9njreasurer Deputy Treasurer.
l
Da Signature of Campaign Treasurer or DeputyTreasur d'
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001,F.A.C.