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.
%
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
1,31 Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First,
`, avaA Abuobai dQ
Middle, Last)
El bad r i
3. Address (include post office box or street, city, state, zip
code)
PC,EJoX y 3H Z
Or lgy)C(o, EL 32261
4. Telephone
( )
5. E-mail address
SorokeltadVt@ cribcom
6. Office sought (include
3- c a0 tt
C
district, circuit, group number) C
Comyy-Viss oy eg. / VIsk'��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
IEJ Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer
� r ie i*
or Deputy Treasurer
Dcxv i S
11. Mailing Address
335
N
Ma Inol;0 Ave. -*Iabq
12. Telephone
( )
13. City
frlavldo
14. County
Orar9c
15. State
F--
16. Zip Code
( ?.:ci
17. E-mal address
111CDe -64keilcxcdr,POiorlortlo.can
18. I have designated the following bank as my `2 Primary Depository ❑ Secondary Depository
19. Name of Bank
I(0- Green ri
20. Address
11 Ica, 5 Qrav5e. RQ
21. City
Qrlavd0
22. County
araonse
23. State
FL_
24. Zip Code
3.2 )
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
2/6/ I
26. Signat e of Candidate
X irz l Eby,
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, 011'61- paVl. , do hereby accept the appointment
(P ease Print or Type Name)
designated above as: JZI Campaign Treasurer
•
6/5/ f. X
puty Treasurer.
Date Signature of Car aign Treasurer o eputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.