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Home My Public Portal AboutAppointment 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): p_ Initial Filing of Form Re -filing to Change: Treasurer/Deputy Depository Office Party 2. Name of Candidate (in this order: First, Middle, Last) Ni Co \<-4C- c 'FoQrte110 Spr'� e 3. Address (include post office box or street, city, state, zip code) tr-- 12l t�eo,d; 4. Telephone ( L. ? )4-t8q36% 5. E-mail addre DC\A,,\�, �LLj2?©9 ()1(c,,\ ;e nicole;teSVInCrtt)vv 6. Office sought (include district, circuit, group number) <<AkA, C Cjevv\ SS.oh \ ��S�r�Cr 3 i �I 7. If a candidate for a non • artisan office, check if applicable: My intent is to run as a Write -In candidate. 8. If a candidate fOr. 'artisan 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 ❑ Campaign Treasurer ❑ Deputy Treasurer 10. Name ofe -f Treasurer or DeputyTreasurer t1 ccA e `ti2,1.1.0 { c , n (--- `> 11. Mailing Address 12-11 Ce. 1 l' I 12. Telephone (tI D'1 )z -1(N36 s 6 13. City D6,6(.1/\.,... -t) 14. County Ct)frk, 15. State L 16. Zip Code 2?),6c( 17. E-mal address n'«le4-ems weA-ekes s l r.., or . ce 18. I have designated the following ban as my Primary Depository ❑ Secondary Deposkory V 19. Name of Bank C. 1ov\S 1Jc-kv\K. 20. Address i64S E e )c ev- r 21. City OVAC\tAL-C, 22. County QY-0\V1 23. Stag F L 24. Zip Code `)32 boy UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVV 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 Co (372- I 26. Signature of Candidate ._ 27. j� ' T(reasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1, 1 yl C -C A'C CCe xtr 2 l D < ii ✓` , do hereby accept the appointment (Please Print o ype N e) designated above as: a Campaign Treasurer Deputy Treasurer. 60/3(2\ X _.._._ _ _ Date Signature of Camp ' n reasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.