HomeMy Public PortalAboutAppointment of Campaign Treasurer-- -
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.
2 E{'a•k '
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
® Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy X Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
Samuel Kent Chambers
3. Address (include post office box or street, city, state, zip
code)
3333 Pelham Rd. Orlando, FI. 32803
4. Telephone
(407 ) 538-1787
5. E-mail address
schambers206@gmail.com
number)
7. If a candidate for a nonpartisan office, check if
6. Office sought (include district, circuit, group
Orlando City Council District 3
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 ❑ No Party Affiliation fl Party candidate.
-In
9. I have appointed the following person to act as my X
Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Samuel Kent Chambers
11. Mailing Address
3333 Pelham Rd. Orlando, FI. 32803
12. Telephone
( 407 ) 538-1787
13. City
Orlando
14. County
Orange
15. State
Florida
16. Zip Code
32803
17. E-mail address
schambers206@gmail.com
18. I have designated the following
bank as my X
Primary Depository
Secondary Depository
19. Name of Bank
Commerce National Bank & Trust
20. Address
1201 South Orlando Avenue, Suite 100
21. City
Winter Park
22. County
Orange
23. State
Florida
24. Zip Code
32789
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
February 11, 2021
26. Signature of Ca idate
X AAA , Oatlhlr�� i
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Samuel Kent Chambers , do hereby accept the appointment
(Please
designated above as:
February 11, 2021
X
Print or Type Name)
Campaign Treasurer
X /MP
Deputy Treasurer.
N/Cn�/)
Treasurer
Date Signature of Campaign Treasurer or Deputy
o..1.. 4e q nnni G A r
.7
DS -DE 9 (Rev. 10/10)