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):
❑ Initial Filing of Form Re -filing to Change: J Treasurer/Deputy a Depository ❑ Office ❑ Party
2. Name of Candidate (in this order. First, Middle, Last)
it c_ i1 p
,, Ti Trnrl e l l ° Spr1, 2 r
3. Address (include post office box or street, city, state, zip
code)
1211 \' -eo, d; �, b r..
Or\c .AA, F 328DW
4. Telephone
(`i0-1 )y843bsc,
5. E-mail address
ni coitH.t®
mutt 4%tsvtriywke'•CmM
6. Office sought (include district, circuit, group IOilmber)
v c\ Gov\ &D C I -Vti Go -vv.\ ► SS; on
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 a • 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
NI Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
GUSA-1%n Ako-e5 c-Ceo'ori o
11. Mailing Address
3355 1 sso►-. 1--o.\<.e. br^ -i' 3q Co
12. Telephone
(172 )333 65D2
13. City
OC`atr‘ coo
14. County
C7Nr-CMG
15: State
F L
16. Zip Code
32.81 f
17. E-mail address
s4Jo®nicbkiit5(i)ri,n •er. 001
18. I have designated the following bans rimy o Primary Depository`s [] Secondary Depositor
19. Name of Bank
v.. 1 rtAsr
20. Address
2-305
G d evvo•4er -r
21. City
0e\ av%6o
22. County
Dray\ e.
23. State ,
L
24. Zip Code
328 O 1
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HA EAD THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
(3, /21 /2\
26. Signature of Candidate
X )v
27. Treasurer's AcceptanceAc° of Appointment (fill in the blanks and check the appropriate block)
I, elUSVCAN/0 Piz Jyio , do hereby accept the appointment
designated above as:
cb125f ?al
(Please Print or Type Name)
❑ Campaign Treasurer Deputy T su
x
Date of moaian Treasurer or Deputy Treasurer